SENIOR BILLING SPECIALIST

Avow Hospice•Naples, FL

7d•$25 - $28•Onsite

About The Position

Under the direction of the Director of Revenue Cycle and/or Supervisor of Revenue Cycle responsible for billing, private insurance negotiations, regulatory compliance related to billing and patient accounting systems.

Requirements

Bachelor's Degree (B.A.) or equivalent from four-year College or technical school; or five plus year’s related experience and/or training; or equivalent combination of education and experience.
Current Driver’s License.
Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions ; Uses equipment and materials properly; Uses proper body mechanics; Meets all infection control and Standard Precaution directives; Meets all job-relevant OSHA and Fire Safety Standards; Attends all mandatory in-services.
Patient Confidentiality - Maintains privacy and confidentiality of patient's Protected Health Information (PHI) according to HON organizational policies and procedures.
Experienced in hospice and/or healthcare billing software; word processing software; spreadsheets and general computer usage.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in standardized situations.
Must be able to stand, walk, stoop, kneel, crouch, or crawl up to 1/3 of work time; sit or use hand to finger, handle, feel, talk or hear over 2/30 of work time; reach with hands and arms 1/3 to 2/3 of work time.
Must be able to lift up to 25 pounds.
Special vision requirements; close vision (clear vision at 20 inches or less); distance vision (clear vision at 20 feet or more); color vision (ability to identify and distinguish colors); peripheral vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point); depth perception (three-dimensional vision, ability to judge distances and spatial relationships); ability to adjust focus (ability to adjust the eye to bring an object into sharp focus).

Nice To Haves

Medical Reimbursement Specialist Certification preferred

Responsibilities

Follow compliance of regulatory compliance requirements related to billing and collections.
Completes all billing functions, daily, weekly and monthly. (Medicare, Medicaid, third party, self-pay, Hospice Residence)
Completes all payor source eligibility and verifications (Medicare, Medicaid, Private Insurance) Completes all billing workflows Electronic Health Record System
Contacts all direct pay accounts to assist with financial questions and verification of eligibility for financial assistance.
Assist SSC with any information that arises pertaining to billing questions.
Completes final process to submit the Medicaid applications.
Maintains and reviews, as necessary, the billing systems, including patient’s accounts receivable.
Prepares all patient financial packets
Bills related software for Medicaid, Medicare, and private insurance.
Completes billing and collection functions.
Identify accounts that qualify for charity or bad debt write-off
Maintains current information on Medicare and Medicaid.
Attends committee meetings and task force meetings as assigned.
Participates in in-services for employees: a) Medicare/Medicaid policies and b) billing issues.
Completes all follow up necessary for Medicare, Medicaid, and private insurance claims processing.
Researches and resolves any claims issues to get the claims finalized.
Back up to the Lead Billing Specialist entering all deposits into the accounts receivable system.
Assist with downloading electronic remittance advices into practice management system and process accordingly.
Reconciles all payor sources, which may consist of making adjustments.
Completes write-off request for direct pay accounts and submits to Director of Revenue Cycle for approval.
Completes all Medical Records request for case managers from private insurance companies to obtain authorization for payment.
Receives and resolves any patient and/or family questions about the billing.
Verifies all Medicaid patients’ eligibility on the first of each month.
Initiates Travel Patient Agreements and Authorization for Services that are identified in the workflow
Initiates Authorization for Services that are identified in the workflow
Reviews patient account balances for credits and process refunds if appropriate
Participates in aging meeting with CFO and Director of Revenue Cycle when the benchmark is greater than 9% over 120 days.
Participates in weekly team meeting
Participates in weekly 1:1 meetings
Compose and mail out benefit summary letters (Commercial Insurance, Medicaid, and SelfPay)
Send notifications of hospice admission and/or deaths to DCF
Process Medicaid applications and follow up on additional information requests from DCF to process the application
Check status regularly of Medicaid applications in process and inform patient’s Social Worker of status including any new information required
Notifies contracted hospitals when a patient chooses Hospice while in their hospital
Notifies contracted Nursing Facility when a resident at their location as chosen admission to Hospice Care and when patient is discharged from Avow.
Field phone calls from outside vendors, patients/families, etc. and assist with billing concerns
Works together with team and other organizational departments to ensure that the needs of patients are being met in relation to billing and authorizations.
Completes weekly insurance pending authorization report.
Other duties as assigned by Director and/or CFO.