ESSENTIAL FUNCTIONS

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

A. Third Party Payer Processes (Third party payers include Medicare, Medicaid, Medicare Advantage Payers, Medicaid Managed Care Plans, Long Term Care Insurance Plans and other third party payers.)

Verifies electronic charges on claims and enters all other charges to ensure claims capture all billable services provided.
Prepares and submits facility claims to third-party insurance carriers either electronically or by hard copy billing.
Secures needed medical documentation required or requested by third party insurances.
Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains.
Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers.
Works with physician or medical record staff to ensure that correct diagnosis/procedures are reported to third party insurance carriers.
Works with medical record staff and contract services providers to ensure that all CPT codes and modifiers are reported to third party insurance carriers.
When the primary third party payer pays, the secondary payer or resident/power of attorney is billed.
Keeps updated on all billing and benefit changes for third-party insurance carriers.
Posts third-party insurance remittance vouchers.
Monitors claims for missing information and authorization/control numbers.
Pre-authorizes all necessary services with third-party payers to ensure proper payment is received.
Verifies third-party payer coverage prior to admission to facility.
Utilizes electronic systems for submitting claims to and receiving remits from all third-party payers as first option for billing.

B. Private Pay Billing

Verifies electronic charges on claims and enters all other charges to ensure claims capture all billable services provided.
Submits monthly private pay billing statements to resident or financial power of attorney.
Ensures all private pay co-pays and co-insurance are included on all monthly statements.
Posts all private pay payments in the accounts receivable software.

C. Collections

Follows up on all account balances due per the facilities Collection Policy.
Communicates with resident or appropriate individual to ensure that all issues hindering payment receipt are addressed so receipt of payment can be ensured.
Review aging reports throughout the month to follow up on all unpaid claims.
Maintain percent of bad debt to net revenue below one percent.
Achieve net accounts receivable days at or below 31 days.

D. Month End Processing

Verify census report for accuracy and to ensure all parameters are correct for each resident.
Review Billing Summary Reports to make sure that the total revenue equals the total receivables plus the total adjustments.
Review all "Documented vs. Billed" reports to ensure that the total number of residents and the total service units billed match between Service Documented and Service Billed sections.
Assure receivable account balances match to the month end aging report balances by payer.
Ensure that total cash in the billing software plus miscellaneous deposits equal cash deposited on the bank statement.
Close period when all reports match. The goal is to close the month end by the 12th of each month.

E. Other

Maintains confidentiality of all information.
Completes work within authorized time to assure compliance with facility standards.
Demonstrates knowledge of, and supports, facility mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
Complete the financial section of each admission agreement.
Assist residents with completion of medical assistance applications and verify eligibility via Medifax.
Complete representative payee forms for incapacitated residents.
Coordinate closure related to accounts of deceased residents (Trust account, death certificate, life insurance claims, funeral expenses, final bills).
Serve as a contact person for resident billing and other insurance issues.
Complete resident correspondence with county DHS workers.
Provide as back-up for other billing functions within the corporation.
Assist in other areas as necessary, including but not limited to front desk coverage.

COMPETENCIES

Ethical Conduct – follows all applicable laws, rules, regulations and facility policies that affect our daily transactions.
Financial and Accounting Management – understands the use of resources (staff, supplies, contracts, etc.) affects the financial sustainability of the organization.
Thoroughness – completion of the job description duties completely, timely and in the best interest of internal and external customers.
Time Management – the ability to manage all daily interactions to meet all deadlines set and successfully meet the requirements of the position.
Stress Management/Composure – remaining calm when confronted with a difficult or compromising situation.
Results Driven – attains the results of the position as defined in the job description.
Technical Capacity - proficient in the learning and use of computerized systems, as appropriate to position, to promote efficiency and accuracy including: resident charting systems, billing applications, client data base systems, Microsoft Excel and Word.
Problem Solving/Analysis – obtains factual information in a non-judgmental manner, analyzes the data and makes a reasonable decision from the data gathered.
Customer/Client Focus – performing job duties in the best interest of our customers.
Teamwork Orientation – recognizes the fact that no job can be performed alone and each member of the team adds value to the process and should be treated as such.
Collaboration Skills – working with team members, vendors, customers in a positive manner in order to achieve the desired outcome.
Communication Proficiency – communicate verbally, in writing and with non-verbal cues in a positive, factual manner to meet the needs of our internal and external customers.

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibilities.

WORK ENVIRONMENT

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must have the ability to travel independently throughout the facility to access information from other departments. Must have the ability to sit for long periods of time.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel; and reach with hands and arms. This employee may need to move objects or residents weighing over 50 pounds.

POSITION TYPE/EXPECTED HOURS OF WORK

This is a full-time non-exempt (hourly) position, and hours of work and days are Monday through Friday, 8:00 a.m. to 4:30 p.m. with a half hour lunch break. Some flexibility in hours is allowed but is expected to work 40 hours each week.

TRAVEL

Minimal travel is expected for this position.

REQUIRED EDUCATION AND EXPERIENCE

High school diploma or GED.
One year of experience in accounting or medical billing.

PREFERRED EDUCATION AND EXPERIENCE

Associate's degree in accounting related field.
Two years of medical billing experience.

Learn more about this Employer on their Career Site

Business Office Manager