Do you have experience with Medical Billing for a long term care facility? Are you ready to take your career to the next level? We have a great opportunity with a Non profit organization here in Philadelphia. This company provides services and programs to those with disabilities within the Great Philly area. This is a temp to hire opportunity and our client is ready to interview!
The Reimbursement Analyst has the primary responsibility for the accurate billing as well as the verification of census days and payor class mix. Responsible for entering ancillary charges and therapy charges as appropriate; reviewing the aging and follow up with all denied or partially paid claims; rebilling of denied claims if appropriate; monthly review of the aging to identify outstanding balances and potential collection issues; quarterly identification of bad debt and processing of requests for write-offs; and provides customer service regarding billing issues to residents and other affiliations in accordance with HIPAA regulations. All essential job responsibilities will be executed in accordance with policies and compliance/ethics guidelines.
ESSENTIAL FUNCTIONS, QUALIFICATIONS & SKILLS:
Census Entry and Balancing
On a daily basis, the daily census is entered and balanced to the daily census report provided by the Admissions Director.
Month end census is balanced to ensure accurate payor class mix and Medicare RUGs categories
Ancillary Charge Entry
On a daily basis, ancillary charges are entered and balanced by comparing the charge listing and posting journal.
Therapy charges entered by the Therapy Department are reviewed and balanced for accuracy comparing the Therapy logs and the billing journal
Claim file for Medicare is created in the billing system and reviewed for accuracy according to Medicare guidelines
Claim file for Medicaid is created in the billing system and reviewed for accuracy according to Medicaid guidelines
Commercial Insurance claims are printed and reviewed for accuracy according to the CI’s guidelines
Monthly Review of Aging Report/Claims Resolution – All Entities
Aging report is reviewed to identify unpaid balances on account.
Denied claims are reviewed and resubmitted to the appropriate payor.
Medicare A Bad Debt Calculation/Write-off
Bad Debts and adjustments will be identified through aging review. Both will be documented and written up for proper approval according to the W/O and adjustment policy and procedure by the last day of the month.
Census Reconciliation & Billing
Weekly census logs are updated from daily time sheets received
Weekly census is updated to monthly billing reconciliation report which calculates charges for each payor.
A/R amounts are entered into accounting system prior to month end close.
Claims are submitted to each payor source: Medicaid claims are manually keyed in
Claims monitoring, research and resolution for denials or rejections received as well as any claim outstanding for more than 30 days.
EDUCATION & EXPERIENCE
In addition to the necessary skills and experience to perform the responsibilities outlined above, there are a number of traits that a successful candidate will possess.
Bachelor’s degree preferred but not required
A strong understanding of Medicare, Medicaid and Commercial insurance billing processes
A minimum of five (5) years billing experience in a long term care facility in PA are required.
Please apply with your CV to: