Billing Specialist

Job Duties

Admission Function:

• Call Medicare for benefits/eligibility and days available for billing. Call any other insurance for benefits and preauthorization if needed.
• Meet with the families on signing all paperwork in the admission agreement with explanation of services. Collection of insurance cards, P.O.A. and any other paperwork pertinent to their length of stay.

Billing Function:

• Performs billing of services to residents and all third party payers, including private pay, Medicaid, Medicare and Hospice.
• Ensure all billing is entered into Reliable and Sigma Care.
• Answer telephone calls from insurance companies, residents/families, co-workers from other departments to ensure correct information for billing.
• Ensure system updates are performed in timely manner
• Update NAMI information on a monthly basis
• Perform Medicare billing, ensuring compliance with Medicare billing regulations, such as itemizing ancillary charges, utilizing appropriate diagnosis codes and reviewing appropriateness of rugs coding with MDS nurse.
• Ensure Medicaid billing is done weekly. Checking remittance status and amount through hotline phone number each week.
• Ensure Private Pay bills are billed out in advance each month.
• Prepare monthly bill days report and balance with census and room and board charges.
• Call and prepare paperwork for bed hold. If resident is not Medicaid and is discharged to the hospital and wants to hold the bed, collect 3 days bed hold by noon the day after transfer. If no bed hold, call to verify and prepare paperwork to be mailed out with date mailed, initials and copies to bed hold file and chart and noted in MCMEMO.

Accounts Receivable Function:

• Record all payments into Reliable system by adjusting the residents accounts receivable sub ledger and appropriate cash accounts. Make sure after payments are posted, buckets are balanced.
• Prepare Medicare credit balance report and any other reports requesting billing information.
• Prepare paperwork for refunds due.

Medicaid Approval/Certification Function:

• Medicaid application process, meeting with families, collecting required paperwork and scheduling videoconferencing.
• Once resident becomes Medicaid eligible, advise pharmacy and enroll resident in Medicare Part D online.
• Review Medicaid Pending cases with Department of Social Services and/or Medicaid caseworker. Advise Social Services on problem cases.
• Follow-up on requests by the Dept. of Social Services for recertification and approval.
• Contact Medicaid with problems of recertification and budget determinations.
• Attend educational meeting regarding insurance coverage, especially Medicaid.

Collection Function:

• Contact responsible parties regarding overdue payments.
• Utilize collection agency for past due accounts. Update collection agency database with pertinent information regarding past due account.
• Advise management of seriously past due accounts and advise on level of allowance for uncollectible needed for write offs.

Other Functions:

• Provide backup for resident bank person when needed.
• Perform other accounting and/or business office functions as needed.