Job description

Company Overview St. Mary’s Nursing & Rehabilitation Center is a dedicated facility providing long-term care, short-term rehabilitation, and respite care services. We prioritize respectful and compassionate care for our residents, ensuring their individual needs are met with understanding and love. Job SummaryResponsible for patient/resident billing in Skilled Nursing (Healthcare) divisions. Inclusive of primary medical billing, secondary medical billing, and all ancillary patient/resident expense items. Job FunctionsEvery effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties to be performed. The omission of specific duties does not exclude them from the position if the work is similar, related, or is an essential function of the position. Duties and Responsibilities: · Responsible for patient/resident billing for all Skilled Nursing (Healthcare). Inclusive of primary medical billing, secondary medical billing, and all ancillary patient/resident expense items. · Performs Daily Census Reconciliation. · Responsible for preparing Medicare Part A, Medicare Part B, Medicare Managed Care, Third Party Insurance, Medicaid and Private Pay billing. Responsible for organizing Medicare appeals and all correspondence for Medicare and insurance issues. · Creates and implements policies and procedures for all aspects of patient/resident billing. · Stays abreast of changes in legislation and updates to laws and compliance regulations of Medicaid and Medicare. · Ensures recertification of insurance contracts which will include Medicare Recertification. · Creates and manages all Medicaid applications, including, the startup process-contacting the resident’s family, discussing the process, and obtaining all requirement documentation. Keeping track of application completion and assisting families with the application process. Following up with the Medicaid representative on application status submitting additional information to Maryland Medicaid as requested. Submitting a determination, annually, for all Medicaid residents. · Audits claims for completeness and accuracy prior to submitting them to ensure clean claims. · Performs collection calls to the resident’s representative for residents' private resource due. · Accurately transmits electronically claims for Medicaid and Medicare billing each month in a timely manner. · Maintains Medicaid and Medicare Logs and other Cost Reports related schedules including preparation of Credit Balance Reports. · Creates and submits coinsurance claims with EOB's attached once Medicaid and Medicare payment arrives. Maintains Medicaid co-insurance write-off log (65/35). · Immediately notifies CFO and Administrator of audits, Office of Attorney General Notifications, Medical, or Legal authorities which includes IRS and any other regulatory or legal agency. · Ensure s all returned claims are reviewed and corrected on a daily basis. · Recognize problem accounts and notify Controller/CFO to assist in problem solving. · Monitors Accounts Receivable for unpaid claims and communicates with insurance companies to work through denials, etc. in accordance with collection policies. · Generates total billing figures and balances to the census. · Prepares monthly explanations of accounts over 30 days past due for Controller/CFO. Takes appropriate action to collect all monies owed to St. Mary's Nursing Center and keeps Controller/CFO informed of any collection problems. · Maintains strictest confidentiality; adheres to all HIPAA guidelines and regulations, · Attends and participates in continuing education programs. · Consistently displays professionalism and promptness. · Complete end-of-the-month closing tasks as assigned. · Performs other duties as assigned by the Controller/CFO. · Performs monthly Triple Check for all Medicare claims. · Assists residents with their Resident Funds Management Service (RFMS) account. · Responsible for maintaining the Center’s Accounts Receivable in good standing. Key Competencies · Advanced knowledge of the laws, regulations, and guidelines that pertain to Long-Term Care Medicare, Medicaid, Managed Care and Third-Party insurance billing. · Knowledge of the regulations/guidelines of the residents’ trust fund account (RFMS account). · Knowledge of accounts receivable billing and collections computer programs. · Knowledge of the principles, practices, and regulations of long-term care. · Must have the ability to understand and interpret policies and procedures. · Ability to establish and maintain effective working relationships with residents, responsible parties, coworkers, insurance companies, and government agencies/personnel. · Advanced knowledge of Microsoft Office Suite, Outlook, Point Click Care (PCC) and strong internet research abilities. · Must be capable of handling complex situations with residents and family members. · Must be able to maintain the highest level of confidentiality regarding resident related · information. · Must be able to meet the standards of the St. Mary's Nursing Center. Job Type: Full-time Pay: $27.00 - $34.00 per hour Expected hours: 40 per week Benefits: • 401(k) • 401(k) matching • Dental insurance • Employee assistance program • Flexible spending account • Health insurance • Life insurance • Paid time off • Retirement plan • Vision insurance Experience: • medical billing: 2 years (Required) Ability to Commute: • Leonardtown, MD 20650 (Required) Work Location: In person

Requirements