Medical Biller

Job Description:

Title: Accounting Manager 

Location: Paramus, NJ

Pay Rate: $29.09/hr.

Type: Contract

Duties:

Skilled Nursing Facility

• Responsible to obtain reimbursement from Medicare and private insurance companies for skilled nursing care.
• This involves establishing cost for medical services provided and calculating the rate for each level of care based on the Medicare Fee Schedule.
• Process Part A claims in compliance with established Medicare guidelines as well as regulations set by the NJ Administrative Code for Veterans Homes.
• Review, interpret and implement rules, regulations, policies and procedures regarding Medicare billing.
• Attend weekly meetings with MDS Coordinator and Rehab Program Manager to review residents’ level of care and current billing status (UR Meeting).
• Determine (SNF) days available.
• Project when the patient will exhaust his or her benefits.
• Determine when a resident is entitled to a new benefit period.
• Change the resident care level from private to Medicare.
• Update the resident’s reimbursement to reflect Medicare is identified as the primary payer. Verify the qualifying hospital stay is present.
• Implement appropriate medical coding; apply to the UB – 04 form required by Medicare and private insurance companies for proper reimbursement.
• Verify the accuracy of ICD – 10 Codes prior to claims submission (Triple Check Meeting).
• Receive PDPM (Patient Driven Payment Model) classification model from nursing department and calculate rates according to the Medicare Fee Schedule for each claim.
• Provide ancillary vendors with Medicare Part A Census Report.
• Determine accurate charges for ancillary vendors by reconciling invoices and calculating rates according to Medicare Fee Schedule.
• Calculate charges and create electronic file for submission to Medicare.
• Rectify error log report. Correct errors identified after calculating charges.
• Process Commercial Claims – Submit claims to private insurance companies to obtain reimbursement for services provided to residents with Medicare replacement plans.
• Utilize Inovalon (Ability Network) to edit, track and adjust claims.
• Analyze Medicare remittance advice and reconcile with claims to ensure proper payment.
• Process secondary insurance claims – Submit claims to secondary insurance companies.
• Process Commercial Claims – Submit claims to private insurance companies to obtain reimbursement for services provided to residents with Medicare replacement plans.
• Process Medicare Part A claims. (Skilled Nursing Facility) Submit claims electronically to Medicare Intermediary (Novitas).
• Track, edit, adjust and correct claims. Files are created in NTT and submitted to Novitas via electronic claims transmission.
• Receive PDPM (Patient Driven Payment Model) classification model from Nursing department (MDS Coordinator).
• Calculate rate according to Medicare Fee Schedule for each claim.
• Determine spell of illness to capture Medicare Days available for billing purposes.
• Process Medicare Part B claims. (Therapy Billing) Submit claims electronically to Medicare Intermediary (Novitas). Track, edit, adjust and correct claims. Files are created in NTT and submitted to Novitas via electronic claims submission. Import and export files received from Quality Care Rehabilitation Services for contracted therapy services.
• Verify appropriate medical coding; Apply to the UB – 04 Form required by Medicare and private insurance companies to obtain reimbursement.
• Create and maintain reimbursement tables for residents. Set up plans by changing sequence of payment order. Enter resident’s insurance information so that information presented on the Face Sheet is correct. Reimbursement tables must be accurate to achieve proper reimbursement from the correct payer source.
• Process Secondary Insurance Claims – Submit claims to secondary insurance companies to obtain reimbursement for coinsurance.
• Process Commercial Claims – Submit claims to private insurance to obtain reimbursement for services provided to residents with Medicare replacement plans.
• Prepare monthly Medicare Part Census Report. (Keep track of census for Medicare Part A Billing). Determine benefit days available, track remaining days in current benefit period. Project when the resident will exhaust his or her benefits. The accuracy of this report prevents overlapping and duplicate claim submission.
• Change resident care level from private to skilled. The resident care level coincides with Medicare Census. This ensure that the resident is being billed appropriately and the facility is obtaining proper reimbursement according to the resident’s level of care.
• Determine accurate charges for ancillary vendors by reconciling invoices and calculating rates according to Medicare Fee Schedule.
• Change resident care level from private to skilled. The resident care level calculating rates according to Medicare Fee Schedule.
• Prepare monthly Medicare Part A log (maintain a spreadsheet consisting of all charges, payments and coinsurance).
• Analyze Remittance Advice from Novitas and EOB (Explanation of Benefits) from secondary insurance companies and post payments.
• Communicate with Medicare Intermediary (Novitas) and secondary insurance companies to resolve problems when they arise.
• Communicate with ancillary vendors. Establish charges for ancillary vendors. Inform ancillary vendors of residents on Medicare Part A.
• Provide customer service to residents and responsible family members regarding billing inquiries.
• Review and analyze denied processed insurance claims and EOBs (Explanation of Benefits).
• Review, analyze, collect and follow up on self pays for medical services rendered to residents at our facility.
• Follow up on co-payments, deductibles and patient responsibility portions that are the responsibility of the residents at our facility.
• Enter health insurance claim adjustment(s) in WellSky (NTT) to adjust and/or reconcile resident’s account based on claim payment received, patient’s responsibility and EOB information.
• Complete and submit all applicable forms for CMS – 855A Application and Recertification, CMS – 838 Credit Balance Report, Part A Direct Data Entry DDE Users Due for Recertification at all other applicable CMS Forms as needed.
• Process prior authorizations for Medicare Part A and Medicare Part B (as needed).
• Assist in the managing and distribution of the ABN (Advance Beneficiary Notice of Non-Coverage) Letters for facility’s residents.

Skills required:

• MS Office; Accounting Softwares
• Professional organization skills

Experience required:

• Proficient with MS Office- Word, Excel; Reporting; Creating Memos

Desired skills:

• Professional organization skills. Sincere.

Work hours:

• 8AM – 4:30 PM
• Lunch period: 30 min Break

Additional information:

• Dress Code: Casual Formal
• Work from Office or Remote: Office
• Parking: yes