Job Information

Northampton County Nurisng Home Fiscal Specialist - Medicare/Commercial Insurance Biller in Nazareth, Pennsylvania

Detailed Job Posting - Insight GENERAL PURPOSEThe Nursing Home Fiscal Specialist andndash; Medicare/Commercial Biller is responsible for performing professional, specialized medical billing functions within the Billing Office at Gracedale Nursing Home's Business Office. Work requires a specialized skill set needed to organize, prepare, analyze and accurately transact complex claims processing, and all related revenue generating functions, in a large long-term care facility setting, while applying significant attention to the financial impact of the timeliness of work performed as it relates to the facility's revenue cycle. SUPERVISION RECEIVEDThis position reports directly to the Nursing Home Business Office Manager. SUPERVISION EXERCISEDThis position is not responsible for the supervision of other employees or functions. ESSENTIAL DUTIES OF THE POSITIONWorks with internal departments and third party agencies in order to accurately account for proper Medicare and Medicare Advantage plan billing in accordance with Medicare regulations. In addition, accurately process all Hospice, Commercial working aged, and coinsurance plan claims billing for supplemental or secondary insurance plans for all facility residents in a time sensitive manner. Performs input and verification of daily resident census information in software system, including preparation of new admissions, insurance verifications and payor status on a rotating basis. Completes monthly reconciliation of Census Days. Verifies and maintains all detailed information relating to third party insurance payors and authorizations. Tracks Medicare and non-Medicare skilled resident census days. Maintains hospice and respite information for accurate billing purposes. Performs detailed accounts receivable reviews in order to identify complex claims requiring resolution within the timely filing requirements. Utilizes working knowledge of PDPM Medicare billing guidelines.Prepares, imports and posts ancillary billing batches in billing software system on a monthly basis. Researches and resolves underpayments. Performs appeals by following government and third-party payor appeals guidelines. Reviews payor contracts and fee schedules to perform underpayment appeals. Works to identify other payers when possible and ensures all payers and filing order is correct. Works with the third party therapy company to determine Medicare Part B occurrence codes and occurrence onset dates as it pertains to Part B therapy billing. Analyzes professional therapy billing from third party agency for accuracy prior to import of charges into billing software. Reviews Part B claims for accuracy with careful attention to admission dates, hospital stays and order of claims processing. Analyzes claims, explanations of benefits, correspondence, payor website and/or any additional information necessary to identify the next appropriate action toward account resolution. Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources. Imports electronic cash receipts files for cash posting and reconciliation of payments. Follows government and third-party payor guidelines to ensure complete and timely follow-up on claims that have open balances, were rejected, or denied. Transmits claims electronically or on paper as required within timely filing regulations by payor. Answers telephone and receives visitors to office. Provides exceptional customer service by effectively communicating with visitors by telephone, email, or in person. Adequately resolve visitors' issues, or directs visitors to appropriate staff able to provide assistance. Interacts with Gracedale Administration and County management, other employees, vendors, family members, residents, appointed representatives on a regular basis in order to provide the highest level of customer service. Complies with all laws, regulations, and industry standards. Completes related reports a