Position Summary:The Billing Specialist is a member of the Billing Office and is responsible for coordinating the billing of claims received from the facilities.Essential Position DutiesSubmits reimbursement claims to third parties (insurance health plans, government agencies, etc.) for services rendered at assigned facilities.Ensures claims have the required information in the specified format. Reviews claims for errors prior to submission.Submits claims within the required timeframes to ensure consistent cash flow and reduce risk of technical denials for untimely filing.Follows up on claims to ensure third party or government agency received the claim:Electronic billing verification no less than 48-hours after claim submission.Hard copy billing no less than 14 days after claim mailed.Coordinates receipt of insurance authorization with facility and maintains missing authorization log no less than weekly.Validates supporting documentation prior to submitting the claim including but not limited to balanced census, authorization, etc.Reviews aging no less than monthly and identifies unpaid accounts. Completes follow-up on all unpaid accounts monthly.Notifies facility of cash posting and revenue errors and makes recommendations for correction.Records billing and collection notes in the account receivable software.Responds to requests from various departments and facility staff.Responds to collection and audit requests timely.Performs other tasks or duties as assigned.POSITION QUALIFICATIONSCore Competencies/Skill SetsAbility to plan, organize, implement, and interpret the department goals, objectives, policies and procedures necessary to maintain a sound business operation.Ability to read, interpret and analyze AR records and reports.Possess knowledge of reimbursement regulations as well as laws, regulations, and guidelines pertaining to healthcare.Ability to work harmoniously with other personnel and develop/maintain good personnel relations and employee morale.Ability to work independently, to follow instructions, and to accept constructive feedback.Ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel and the general public.Sufficient verbal and written communication skills to perform the tasks required.Professional Experience/Educational RequirementsTwo years SNF business office and billing experience.
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