Performs all electronic billing and follow up on claims for residents and families, Medicare part A and B, Medicaid Sate billing, third party insurance carriers, guarantors, doctors, lawyers and others, over the phone or by letter correspondence. Functions as a liaison between Corporate Accounting, Social Services and the Nursing departments to coordinate the gathering of accurate daily patient census information. Calculates appropriate billing charges from information obtained in patient charge logs.

Essential Job Functions and Responsibilities:

Performs billing functions

• Checks and verifies identification of patient guarantor, proper selection of insurance carrier,

etc. who is responsible for paying charges for services.

• Reviews charges and computer billings to assure accuracy, completeness and appropriateness.

• Completes and processes third party billings.

• Ensures that multiple billings are mailed when more than one payor has responsibility for paying a portion of the total bill.

• Follows up to obtain any missing information via telephone, teleprocessing or mail contact with responsible party, employer, third party payor, etc.

Performs account analysis

• Performs a daily analysis on current balances to determine accounts which should receive further follow-up or other special attention, in keeping with established guidelines.

• Brings any unusual occurrences to the attention of the Corporate Accountant.

Performs customer service activities

• Answer inquiries regarding billings.

• Explains information on billing forms. Obtains new and/or updated information on accounts and posts to designated records.

• Resolves questions and problems, and refers bills to other appropriate staff members for further follow-up as required.

• Working with residents, families and social services, submits redeterminations quarterly to the state.

• Researches or follow-up on all collections with Medicare, Medicaid, private residents, or responsible parties to ensure that all charges are received and credited to the proper accounts.

• Works with responsible parties to resolve questions and problems with overdue/outstanding accounts.

• Keeps Corporate Accountant apprised of status on delinquent or late accounts or other unusual occurrences.

Medicare/Medicaid billing

• Responsible for Medicare/Medicaid submissions on a monthly basis.

• Gap billing done throughout the month to ensure that the alternate payor source is billed accordingly.

• On-going communication with DSS caseworkers pertaining to any admission/discharge activities as well as any financial changes affecting the residents applied income.

• Completes the Medicare Quarterly Credit Report to ensure that payments to the facility are uninterrupted.

• Responsible for inputting ancillary charges, daily census and any other miscellaneous task in order to complete the month end process.

Performs miscellaneous duties

• Prepares monthly aging for financial statement package.

• Processes resident security deposits, maintains ledger of funds held.

• Post sales and deposits on an ongoing basis.

• Preserves the confidentiality of all patient financial information. Disseminates information according to established policies and procedures or with authorization from the Corporate Accountant.

• Develops and implements quality assurance guidelines for billing services.

• Recommends or makes necessary changes to enhance or improve systems and efficiency.

• Performs additional related duties, as assigned by administrator or as dictated by responsibilities.

Educational / Minimum Requirements:

High School Diploma. Minimum of five years’ experience in a Skilled Nursing Home. Experience in health care billing; including part A & B Medicare, Medicaid, Medicare Managed Care, Commercial and Private Pay Billing is required. Medical terminology required.

Additional experience in collections, office coding skills, including documentation, experience in typing, data entry, and computer skills. Familiarity with insurance claims processing and managed care rules/regulations.

Computer System Experience: Point Click Care (PCC), PC ACE PRO 32-Medicare Electronic Billing, and IVAN-Electronic Billing System a plus.

State/Federal Mandated Licensure or Certification Requirements:

None

Bristol Hospital Mandated Educational Requirements:

General orientation at time of hire. Fire/Safety/Infection Control annually. Other programs as mandated by Hospital.

Special Requirements:

Strong computer skills; aptitude for learning new software programs and ability to assimilate software changes. Some literacy in word processing. Excellent organizational and interpersonal skills. Ability to motivate staff.

Physical Requirements:

Prolonged sitting at a desk and/or computer terminal. Significant paperwork requiring extensive eye usage. Physically able to handle paperwork and filing. Ability to communicate by speaking and hearing.

Work Environment:

Normal office conditions.

Cognitive Requirements:

Strong interpersonal skills; ability to deal effectively with Physicians, clients, and other related professional personnel. Excellent mathematical and analytical skills. Detail orientated personality. Excellent written and oral communications skills. Ability to work independently with minimal direct supervision necessary. Deadline oriented. Problem solving skills.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.