Billing Specialist

GRAND TRAVERSEPAVILIONS - BILLING SPECIALIST SUMMARY Responsiblefor accounts receivable billing and collections, including correspondence,phone calls, and initiation of legal proceedings as necessary. Assist withfinancial reports, resident trusts, and third-party billing. Reports to Controller/AssistantDirector of Finance. RESPONSIBILITIESAND DUTIES 1.Performbilling functions including data entry (or import) of ancillary changes andtimely transmitting accurate claims to insurance companies, Medicare, Medicaid,PACE, Hospice, Medicaid Waiver programs and generating private statements. 2.Timelyfollow-up on all claims that are rejected or not paid correctly for all payersources. 3.Preparefor and attend weekly/monthly accounts receivable aging review meetings. 4.Updateand maintain resident financial information including maintaining copies ofproof of coverage, signed contracts, electronic verification of insurancecoverages and follow up on coverage changes or lapses and any other informationnecessary to bill. 5.Developsrelationships with residents and responsible parties including explaininginsurance and entitlement program coverage, reinforcing expectations forpayment, answering billing and payment questions. 6.Performsteps of the collection process, including letters, phone calls and initiationof legal processes. 7.Workconstructively with the Department of Human Services Outstation worker toensure superior support for all responsible parties and clear communication ofconcerns over initial or redetermined eligibility. 8.Understandsthe rules and steps regarding entitlement to Medicare Part A, B, C and Dcoverage including consolidated billing, Prospective Payment System (PPS) ratedeterminations and Minimum Data Set (MDS) assessment schedules. 9.Understandsthe rules and steps regarding entitlement and approval process of Medicaidcoverage and benefits. 10.Understandsand follows rules and procedures for Medicare Demand Bills, Interim PaymentAdjustments, Denial of Benefits, and Medicare as Secondary Payer. 11.Understandsand follows special billing instructions for billing of Pneumococcal Pneumonia,Influenza Virus, and Hepatitis B vaccines. 12.Iseducated and up to date with the various laws governing the Medicare programand strives to protect the facility and its employees from fraud and abuseexposure, including by participating in the triple check process. 13.Mayperform accounting duties such as receipting payments, reconciling accounts andmaintaining documentation. 14.Knowledgeof Resident Trust Fund disbursements and accounting procedures. 15.Dailyreview to ensure active payers for all residents and census accuracy. MINIMUM QUALIFICTIONS ·HighSchool Diploma

• Excellenttyping and automated data entry skills.
• Proficiencywith business office equipment.
• Excellentinterpersonal skills, including telephone etiquette.
• Accuracyand attention to detail.
• Nursinghome billing experience is required; assisted living billing experience ispreferred.
• Experiencewith Point Click Care and Waystar software preferred.
• Abilityto explain expectations and deal constructively with conflict is essential.
• Abilityto read and understand electronic remittance advice is also essential.