Billing Specialist

Summary

Responsible for handling initial third-party payer billing (Commercial,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