Skilled Nursing Facility Billing Specialist

POSITION SUMMARY:

To develop, implement and maintain systems to operate the business office in an effective manner to ensure the facility operates in a financially sound manner. To maintain admission and financial systems in compliance with federal, state, and local requirements. Responsible for the billing and collection of all revenue owed to the facility. Will be responsible for the organization and maintenance of all records related to billing and collections in an effective and efficient manner.

ESSENTIAL DUTIES:

• Responsible for all billing and accounting activities of the facility, providing appropriate reports to the Administrator. Produces Aged Accounts Receivable reports, Revenue Journals, and all corresponding reports on a monthly basis. Reviews insurance claim denials, coordinating with the Manager of Social Services, Manager of Nursing, and varied Department Managers to resolve denials and billing problems. Reviews all ancillary charges for accuracy and inputs into the AR system. Custodian of Resident Trust Funds.
• Responsible for entry, paper claims, and electronic transmission of billing.
• Posts all payments into computer Accounts Receivable as they are received, completing and submitting income reports to Finance Department for all revenues, whether checks or electronic funds.
• Posts debits and credits to Resident Trust Account, assists with monthly reconciliation and quarterly statements.
• Assist with weekly petty cash count.
• Monitors and updates census daily.
• Completes Medicare ABN’s.
• Responsible for accessing referral for payor source, pharmacy, eligibility, days of availability and prior approvals if needed. 
• Input invoices for labs, x-ray, office visits into EHR for Medicare A residents. 
• Follows changes in Medicare and Medicaid reimbursements requirements and implements changes appropriately. Obtains computer program version updates to ensure compliance with insurance electronic billing requirements.
• Coordinates communication in the facility through use of telephone, pagers, fax, e-mail, and modem. Coordinates errands daily, visiting post office, and other locations as necessary.
• Assists with the organization of admission paperwork and initiates computer files for new patients. Responsible for setting up financial files for all residents and all paper and communication needs in the office.
• Works with Social Worker, families, and residents to assist in initial completion of Medicare/Medicaid paperwork and renewals.
• Collects required statistics and works with the Administrator and accountants to create cost reports as required.
• Attends all mandatory agency in-service/educational programs as scheduled during the evaluation period. Attends annual intermediary educational programs and others as deemed necessary for successful completion of assigned duties.
• Demonstrates safe practices by using proper body mechanics, following policies for sharp/dangerous material handling and disposal, and reporting and/or acting to correct unsafe or costly conditions.
• Performs other duties assigned by supervisor to promote efficient operation of the facility 

KNOWLEDGE, SKILLS, AND ABILITIES:

• Must have a thorough knowledge of Skilled Nursing Facilities billing practices, and Medicaid and Medicare billing. 
• Requires a thorough knowledge of the federal, state, and local regulations applying to the collection of revenue as a Medicare certified Health Provider, including interpretation and transmission. 
• Must maintain current knowledge of federal and state requirements within rapidly changing environment of federal, state, and local regulations as applied to the Health Care Industry.
• Requires the ability to legibly document and maintain financial records, files, logs, and produce reports. 

EDUCATION, EXPERIENCE, AND OTHER REQUIREMENTS:

• Associate’s Degree in Business Office Management, Accounting or related field is preferred. In lieu of education work experience with a minimum of 10+ years’ experience with Medicaid, with extensive knowledge of North Carolina Medicaid Programs and Processes.
• Demonstrated experience and expertise working directly with County Department of Social Services (DSS) Medicaid Programs, including eligibility requirements, application processes, case coordination, and related Medicaid regulations.
• Specialized knowledge and training in Medicaid Long Term Care (LTC) eligibility and application processes.
• Completion of Training in Transfer of Assets and related Medicaid eligibility requirements
• Completion of Training in NC Medicaid Managed Care and Long-Term Care (LTC) Programs
• Completion of Training in EBCI Tribal Option, Tribal Membership, and Managed Care.
• Training and experience in Long Term Care Medicaid Application, including the eligibility process and documentation requirements.
• Ability to navigate and apply complex Medicaid eligibility rules, particularly those involving long-term care, assets transfers, managed care and EBCI Tribal Option.
• Nine to twelve months would be necessary to become proficient in facility specific software and processes, Long-Term Care rules and regulations, as well as CIHA policies and procedures. 
• Additional computer experience in Word, Excel, and Power Point, etc. is preferred.

WORK ENVIRONMENT:

Works in office environment, some driving is required. Work consists of standing, sitting, and walking with several hours daily keying information into computer. Occasionally, moderate lifting is required.

PHYSICAL REQUIREMENTS:

Job duties can be mentally and emotionally stressful at times. Close mental concentration and attention to detail are required for most administrative tasks that can be for short or extended periods. Physical activities require the ability to walk, sit, reach and lift objects of approximately twenty pounds. Must have visual acuity, manual dexterity, and the ability to speak and hear.

CONTACT WITH OTHERS:

• Has frequent telephone contact with patients, families, coworkers, and health professionals where tact, courtesy, and diplomacy are required to maintain positive relationships. 
• Requires sensitivity to others while dealing with patients and their families who may be under stress while dealing with issues of disease, poor health, or old age.
• Frequent contact with federal, state and tribal authorities relating to clarification of billing issues.
• Has frequent contact with coworkers, other health professionals, residents and their families where tact, courtesy, and diplomacy are required to maintain positive relationships. 
• Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values.
• Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.

COMPLEXITY OF DUTIES:

• Ingenuity and judgment are required to review facts, plan work, deal with facts not easily evaluated, interpret results, draw conclusions and take or recommend action. 
• Each patient must be considered on an individual basis with needs met within federal, state and local regulations. 
• Must have the ability to handle several projects at once while focusing on the accuracy and the agency's overall productivity.

CONFIDENTIAL DATA:

All data is considered highly confidential and strict adherence to all applicable tribal confidentiality policies, procedures and guidelines is required, including but not limited to Indian Health Service Regulations on Privacy, 42 CFR, HIPPA, Code of Conduct, and any applicable industry standards. Improper handling of confidential information could result in damage to patient relations, professional reputation, and credibility of the program. Has access to all patient files, which are confidential and privileged. Has access to all division files, memos, contract proposals, budget information, personnel, all of which would be considered confidential. Must adhere to all tribal confidentiality policies and procedures. May at times be involved with projects requiring access to patient information, which is highly confidential. Damage to program reputation and ill will could result from unauthorized disclosures of information. Has access to departmental files, informal contract and vendor proposals, budget information and personnel files: all of which are considered confidential. Must adhere to all tribal confidentiality policies and procedures. Must adhere to all tribal guidelines, CIHA policies and procedures for working with confidential data as well as federal regulations, including but not limited to HIPPA. An above average degree of discretion is required while handling patient and related medical information.

RESPONSIBILITY FOR ACCURACY:

Requires a high degree of accuracy in billing procedures. Undetected errors could result in minimal or extreme corrective measures on the parts of several agencies. Government regulations, compliance with grants, and third party payers require the submitting of accurate resident information to allow for appropriate reimbursement for resident services. The submission of false or inaccurate information would place the facility at risk for fraudulent claims, resulting in loss of agency certification.

RESOURCEFULNESS AND INITIATIVE:

The Nursing Assistant works under the direction and supervision of a Registered Nurse. Must demonstrate good observation skills with sufficient knowledge to recognize health abnormalities and report them to the patient's primary RN. Requires good organizational skills in order to follow a schedule and calendar of visits for resident care, assemble needed supplies, prioritizing resident needs, and planning visits to make good use of time.

SUPERVISION RECEIVED: 

Works independently, reporting to Administrator for unusual circumstances or problems.

CUSTOMER SERVICE:

Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.