Billing Specialist

Job Description: 

Summary

Responsible for handling initial third-party payer billing (Medicare and managed care) for the purpose of reimbursement of services, cash receipts posting and other month-end charge entry duties; Upholds the philosophy, core values and goals of the organization and ensures that the Christian Mission of EverTrue is realized – “Older Adults Living Life to the Fullest”.

Responsibilities  

1. Initial billing of skilled nursing facility/Anywhere Care claims to third party payers (Medicare, Managed Care, Commercial Insurance) or vendor Medicaid claims (Medicaid, Managed Care Medicaid and Medicaid Hospice) for multiple EverTrue sites, utilizing electronic claims submission

2. Ensures claims are received, and if returned to provider, resubmitted in a timely manner

3. Bills coinsurance claims where the primary insurance pays without issue; Refers more complex or past-due claims to the Senior Billing Specialist as needed

4. Posts cash receipts to Accounts Receivable (A/R) for third-party payer payments

5. May be responsible for filing of Medicare no-pay, benefit exhaust and information claims

6. Responsible for transferring claims to Senior Billing Specialist if:

• Primary payer does not pay expected reimbursement, especially if in conflict with contract terms.

• Claim aging becomes >90 days, or under 90 days and not submitted to payer and acknowledged

• Claim is being audited/reviewed for any reason (ADR, CERT, RAC)

• Claim non-payment/under-payment needs to be appealed

7. Maintains up-to-date technical knowledge of applicable Medicare/Medicaid/Managed Care/Anywhere Care billing rules and regulations via the CMS website, MAC website, etc.

8. Inputs Medicare ancillary charges in billing system in a timely manner

9. Serves as a resource to residents and community billing staff for applicable insurance benefit related issues

10. Serves as backup to RCM Billing Specialist; Handles verification of resident’s Medicare/Medicare Managed Care/Medicaid/Commercial Insurance benefits prior to receipt of third-party billable services

11. May handle small balance adjustments of $10 or less

12. May be responsible for maintaining Medicare Coinsurance bad debt schedule for cost report

13. Handles maintenance of resident income related to retroactive vendor Medicaid authorizations or retroactive changes in resident income

14. Handles Medicaid re-billing of charges related to retroactive vendor Medicaid authorizations or retroactive changes in resident income

Qualifications, Knowledge, Skills & Abilities

• High School diploma

• 1 – 3 years of Medicare billing experience

• Proficient computer skills including Microsoft Outlook, Excel and Word are required

Physical Requirements and Working Conditions

The physical activities and demands described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lifting up to 30 pounds; Pushing/pulling 100 lbs. on wheels; A well-lighted and ventilated working area that has its own temperature control system (air conditioning and heat); The work will have some short notice requests, timelines for completion of tasks or reports and some major projects extending over months; Minimal exposure to infectious diseases and blood borne pathogens; Minimal exposure to chemicals and hazardous waste; Minimal exposure to outside weather conditions.

This job description is intended to describe the general nature and level of work performed by those assigned to this classification.  This job description in no way states or implies that these are the only duties to be performed by those occupying this position.  The job description and job functions described herein are subject to possible modification by EverTrue in accordance with applicable federal, state, and local laws.

Additional Information:

N/A