Senior Healthcare Billing Specialist

Life Care Services•Des Moines, IA

4d•Onsite

About The Position

The Senior Healthcare Billing Specialist is responsible for processing claims for skilled nursing services rendered to residents with third party coverage under Medicare, private insurance, Medicaid, and various co-insurance companies. This role mentors Healthcare Billing Specialists and assigned special projects. LCS provides the opportunity to use talents in a progressive, growing organization that makes a positive difference in the lives of the seniors served. LCS employees participate in volunteer activities, get involved in committees, or collaborate with team members in an innovative workspace. There are opportunities to grow as a professional, serve the community, and enhance the lives of seniors.

Requirements

Minimum of 5 years of experience with healthcare billing, including Medicare, Medicaid and third-party insurance using the UB04 claim format.
Experience with CMS FISS/DDE systems (Noridian, Novitas, Palmetto, WPS, etc.)
Proficient with Microsoft Word and Excel
Knowledge of Medicare, Managed Care and Commercial insurances.
Extensive and current working knowledge of billing and collections of skilled nursing facility claims.
Extensive and current working knowledge of various insurance carriers’ payment regulations including various reimbursement schemes, coinsurance and deductibles, and contractual adjustments.
Working knowledge of HIPAA regulations and compliance.
Ability to reduce claims in the over 90-day categories and maintain per industry standard.
Strong interpersonal and communications skills to be able to work successfully in a team-oriented environment
Strong analytical and problem-solving skills including the ability to understand complex reimbursement structures and the ability to apply contractual and governmental regulations to billing processes.
Excellent oral and written communication skills.

Nice To Haves

Experience using my Unity, Point Click Care, and/or Matrix application and Waystar clearing house is a plus.

Responsibilities

Mentors and assists team members.
Assists in implementing processes and procedures at communities to help improve accuracy and timeliness of billing.
Maintains relationships with insurance companies, and works with payers to determine reasons for denials, corrects and reprocesses claims for payment in a timely manner.
Assists with audit preparation.
Completes special projects as assigned.
Compiles and inputs data for billing; generates monthly bills including electronic transmission and/or paper submission of claims to third party payers.
Ensures compliance with current federal and state government regulations for all billing functions.
Identifies and provides feedback about A/R billing issues to the Billing Services Manager.
Inputs data for Skilled Nursing Facility; skilled and therapy only, submits claims to Medicare, Managed Care, Medicaid, and Commercial Insurance.
Monitors claim processing and payments while accurately recording payments and adjustments within the billing system.
Interfaces with Admissions staff and MDS Coordinator in review of billing information to evaluate accuracy and completeness of information for claims submission.
Develops a culture of customer service and respect in the accounts receivable team.
Monitors A/R aging and follows up on outstanding balances.
Assist in preparation of Medicare Cost Reports and Credit Balance reports.
Runs necessary reports; maintains backup and support documents.
Attends in-service training and education sessions, as assigned.
Performs other duties as assigned.