ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Review and evaluation patient demographic information regarding Medicare A, Advantage and third party billing.
- Review daily Admission, Discharge and Transfer (ADT) report for changes related to Medicare A and Advantage stays and communicate concerns regarding accuracy of said report to appropriate admissions staff.
- Process and bill Medicare Part A (and Advantage) services and all other secondary carriers related to the Medicare Part A (and Advantage) resident stays, ensuring claims are submitted timely and in compliance with appropriate regulatory bodies as well as payer specific guidelines.
- Adjudicate charges, adjustments payments and denials in order to resolve all discrepancies as they relate to Medicare A, Advantage and third party payers in the billing software.
- Work with residents related to co-payments, deductibles and patient responsibility as necessary (as they relate to Medicare A & Advantage stays).
- Ensure coding accuracy (including but not limited to RUGS, hospital stay dates, type of bills, etc.) for Medicare A, Advantage and third party payer claims (as they relate to applicable stays) and work with applicable departments to resolve errors or inaccurate data.
- Post payments from Medicare A, Advantage and third party payers to billing system ensuring total deposits and cash receipt journal are in agreement.
- Ensure accuracy and timeliness of the month end close in billing software as it relates to Medicare A and Advantage stays.
- Attend required seminars on Medicare and insurance billing to keep abreast of regulatory changes.
- Participate in monthly triple-check meetings at all communities to ensure accurate and timely billing as well as regulatory requirements (as they pertain to billing Medicare A and Advantage Claims) are being met prior to claims submission.
- Establish and maintain communication with Managers regarding accounts receivable agings and outstanding balance impact on private pay accounts.
- Review and work aging monthly (at a minimum) to ensure no outstanding balances reach stale dated status.
- Maintain claim denial log for the organization and coordinate document submission is timely and tracked.
- Upload and / or input therapy services for all communities as well as medical supplies, radiology, lab and other charges (WP only) included in consolidated billing into billing software and ensure accuracy of charges.
- Upload daily remittance reports from “ My Ability” software for payment processing as well as providing relevant data with Medicare Part B Biller.
- Perform all other tasks as assigned.
EDUCATION: High School – Advanced degree or working toward
advanced degree preferred.
EXPERIENCE: Three to five years of Medicare Part A billing, claim
adjudication and collection experience with emphasis in a Skilled Nursing setting. Proficient in Microsoft Office, particularly Excel, and computer billing applications.