Billing Specialist

GRAND TRAVERSE PAVILIONS - BILLING SPECIALIST

SUMMARY

Responsible for accounts receivable billing and collections, including correspondence, phone calls, and initiation of legal proceedings as necessary. Assist with financial reports, resident trusts, and third-party billing. Reports to Controller/Assistant Director of Finance.

RESPONSIBILITIES AND DUTIES

1.            Perform billing functions including data entry (or import) of ancillary changes and timely transmitting accurate claims to insurance companies, Medicare, Medicaid, PACE, Hospice, Medicaid Waiver programs and generating private statements.

2.            Timely follow-up on all claims that are rejected or not paid correctly for all payer sources.

3.            Prepare for and attend weekly/monthly accounts receivable aging review meetings.

4.            Update and maintain resident financial information including maintaining copies of proof of coverage, signed contracts, electronic verification of insurance coverages and follow up on coverage changes or lapses and any other information necessary to bill. 

5.            Develops relationships with residents and responsible parties including explaining insurance and entitlement program coverage, reinforcing expectations for payment, answering billing and payment questions. 

6.            Perform steps of the collection process, including letters, phone calls and initiation of legal processes.

7.            Work constructively with the Department of Human Services Outstation worker to ensure superior support for all responsible parties and clear communication of concerns over initial or redetermined eligibility.

8.            Understands the rules and steps regarding entitlement to Medicare Part A, B, C and D coverage including consolidated billing, Prospective Payment System (PPS) rate determinations and Minimum Data Set (MDS) assessment schedules.

9.            Understands the rules and steps regarding entitlement and approval process of Medicaid coverage and benefits.

10.         Understands and follows rules and procedures for Medicare Demand Bills, Interim Payment Adjustments, Denial of Benefits, and Medicare as Secondary Payer.

11.         Understands and follows special billing instructions for billing of Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B vaccines.

12.         Is educated and up to date with the various laws governing the Medicare program and strives to protect the facility and its employees from fraud and abuse exposure, including by participating in the triple check process.

13.         May perform accounting duties such as receipting payments, reconciling accounts and maintaining documentation.

14.         Knowledge of Resident Trust Fund disbursements and accounting procedures.

15.         Daily review to ensure active payers for all residents and census accuracy.

MINIMUM QUALIFICTIONS

·         High School Diploma

·         Excellent typing and automated data entry skills.

·         Proficiencywith business office equipment.

·         Excellent interpersonal skills, including telephone etiquette.

·         Accuracy and attention to detail.

·         Nursing home billing experience is required; assisted living billing experience is preferred.

·         Experience with Point Click Care and Waystar software preferred.

·         Ability to explain expectations and deal constructively with conflict is essential.

·         Ability to read and understand electronic remittance advice is also essential.

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