Facility Billing Coordinator

Department: Billing

QUALIFICATIONS: 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.

Education/Work Experience

• Minimum Associate degree in business or health related field
• 3-5 years direct work experience in business or health related field; pharmacy experience preferred
• Understanding of Medicare/Medicaid/Insurance pay types, medical terminology, and brand/generic medications required
• Intermediate working ability with Microsoft Word and Excel, or like applications

Other Qualifications

• Ability to process bills for assigned facilities representing a minimum of 1500 active residents
• Ability to exhibit strong oral and written customer service skills
• Ability to multi-task and adhere to timelines

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

I. Pre-billing and Billing (70%)

• Reviews all reports and information necessary to make required corrections in the pharmacymanagement system before bills are processed at month end.
• Processes any additional fees as required by contract.
• Prints and review pre-billing report at end of 2nd and 3rd weeks of the month and in billing month end process
• Updates insurance information as required and rebill charges as necessary in a timely manner prior to month end billing.
• Updates facility census daily or as received. Contacts facility to request daily census if census is not being received daily.
• Reviews facility and private pay statements for accuracy, correcting and re-running as necessary, then sends them out in a timely manner.
• Resolves questions and/or concerns from facilities, guarantors, power of attorneys and private pay residents regarding monthly statements and makes corrections or adjustments as needed. These adjustments include things like statement disputes, short pays and similar items.
• Retrieves documents from billing queue for assigned facilities.
• Prepares all electronic billing to facilities if necessary.
• Closes and posts monthly billing within required timeframe. This shall include balancing information between the Framework and AccPac sides of the total Framework system.
• Update Medicaid pending residents weekly.
• Resolves month end rejections caused by re-billings.
• Perform weekly re-pricing function when necessary.
• Complete required composite billing prior to month end statements.
• If and when necessary, process hard copy claims.When required, monitor the spend -down on qualified medical beneficiaries (QMB’s) for Medicaid coverage purposes.

II. Customer Relations (25%)

• Acknowledges and responds to emails and phone calls received by 4 pm of the current business day before leaving shift. Final resolution of issues within 48 hours of receiving email or phone call.
• Makes calls on short payments to resolve billing issues; rebill charges as necessary.
• Working knowledge of assigned facilities contracts and the ability to set up pricing tables as required by contract.
• Provide customer price quotes when requested.
• Collections- follow designated collection/stop med process and communicate to delinquent accounts as needed.

III. General Office (5%)

• Updates resident addresses on returned mail for assigned facilities.
• Filing
• Attends training as provided in order to improve self and quality of work.
• Accepts other duties as assigned.