The Billing Specialist is responsible for Nursing Homes, Assisted Living Facilities, Group Homes, and Private Pay statements.
Duties/Responsibilities
Process third-party billing, claim resolution, and adjudication
Manage FFS and PPS billing
Conduct census balancing and payor verification
Verify insurance and Medicaid coverage
Knowledge of Dual Coverage, MCR D, and Commercial Plans pertaining to Long Term Care
Assist with all customer billing inquiries in a courteous and professional manner
Enter fees and charges in Framework LTC
Prepare daily, weekly, and monthly pre-bills and account audits
Prepare daily, weekly, and monthly reports
Create statements and EOM summaries
Understand and work with residents on account balances
Follow all applicable government regulations including HIPAA
Other duties as deemed necessary by Billing Manager
Qualifications
Able to read, write, speak, and understand the English language
Able to work in a fast-paced environment
Basic computer knowledge skills required
Basic math and analytical skills
Proficient in Microsoft Word, Excel, and Outlook required
Good organization/Attention to detail
Able to work at a moderate speed
Reliable
Problem solver
Able to work various shifts and days
Adaptability to an ever-changing environment
Requirements
High School diploma or equivalent required
Two (2) years’ pharmacy billing experience required (long-term care preferred)
Framework LTC & General computer knowledge & 10-key Number Entry preferred
Knowledge of Sage preferred
Physical Demands
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
May be necessary to work extended hours as needed
May lift and/or move up to 30 pounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
Benefits
Medical, Dental, and Vision insurance
401 (k) (available for Part Time & Full Time EEs)
Company Paid Life insurance
Short-term and Long-term disability insurance
Tuition reimbursement
Personal Time Off (PTO)
Competitive pay with annual performance reviews and merit-based raises