Medicare Coordinator

COUNTY OF BUCKS

• JOB TITLE: **Medicare Coordinator
• JOB CODE: **391
• DEPARTMENT: **Neshaminy Manor/Business Office
• UNION: **00
• FLSA STATUS: **Non-Exempt
  
  

Grade

• POSITION SUMMARY**:
  
  

The Medicare Coordinator must be familiar with daily operations of the Business Office. The primary responsibility is billing Medicare and Insurance, collections, posting of payments and payer denials. The Medicare Coordinator resolves resident and payer billing issues, processes refunds, completes coinsurance billing and compiles report information while ensuring all functions are carried out timely, accurately and efficiently.

• ESSENTIAL FUNCTIONS AND RESPONSIBILITIES**:
• Verifies Medicare Part A and B coverage. Tracks Medicare and Insurance resident days.
• Communicates with vendors bi-weekly and audits charges to ensure the accuracy of consolidated billing practices and procedures.
• Updates fee schedules and Insurance contract rates in software system.
• Coordinates and posts ancillary charges.
• Create transfer files and transmit claims to Medicare and submit UBO4s to Insurance and secondary insurance companies.
• Applies payments and interprets Explanation of Benefits for appropriate follow up action.
• Provide coinsurance billing and follow up with third party carriers on denied and unpaid claims through the collection process.
• Notify responsible party via telephone and certified mail of Medicare or Insurance denial letter.
• Provides back-up to admission process, maintenance of daily census and front desk receptionist duties as needed.
• Submits Benefit Exhaust and No-pay claims to Medicare for tracking purposes.
• Attends Medicare Utilization Review meetings and interfaces with all levels of personnel relevant to Medicare and Insurance billing.
• Collects and maintains statistical information for annual year-end Cost Report.
• Communicates with the Nursing and Therapy Dept for any diagnosis or authorizations related to billing.
• Strong data entry with high degree of accuracy and attention to detail.
• Candidate must have excellent verbal and written communication skills.
• May be required to perform all other duties as assigned.
  
  

Qualifications Required

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High school diploma or equivalent.
• Minimum two years' experience in the business office of a nursing home.
• Knowledge of Medicare, Medicaid and third party insurance with