Reimbursement Billing Specialist: Oakwood Village

BASIC FUNCTION

The Reimbursement Billing Specialist is responsible for computerized billing, reimbursement, third-party filing and communicating with residents and families of Oakwood for the skilled nursing facilities: Hebron Oaks and Oakwood Village East Health and Rehabilitation Center (OVEHRC).

This position is accountable to the Controller.

RESPONSIBILITIES

1. Ensure complete, accurate and timely electronic and paper filling of Medicare, Medicaid and third-party claims daily by resolving claim edits and meeting all appropriate billing requirements.

2. Resolve miscellaneous correspondence received from insurance carriers, attorneys or other requestors.

3. Accurately, clearly, and professionally documents all account changes, updates, and/or instructions for account resolution.

4. Identify and resolve billing deficiencies and escalates accounts when appropriate. Including delay in payment and demonstrated understanding of billing and collection requirements from payors.

5. Tracks and reports trends on billing and collection deficiencies and generate effective plan to resolve.

6. Organize work flow to ensure timeliness of account follow-ups.

7. Manage account follow-up schedule to bring the account collection to closure by escalating billing and collection issues to the Controller.

8. Complete Re-bill requests. Research to determine why bills are returned, correct problem and resend.

9. Verifies that the correct resident documentations and authorizations are on file.

10. Maintain confidentiality of all resident demographics, medical and financial information at all times.

11. Upholds Oakwood’s ethics and customer service standards.

12. Answers questions from residents, staff and insurance companies.

13. Participates in personal training, education and ongoing development to ensure the highest level of knowledge in billing and collection practices.

14. Participates in meetings, education, and brainstorming sessions to improve workflow and processes.

15. Conducts follow-up with insurance companies on outstanding claims.

16. Collects delinquent accounts by establishing payment arrangements with residents; monitoring payments; following up with patients when payment lapse occur.

17. Maintains Medicare bad-debt cost reports by tracking billing, monitoring collections; compiling information.

18. Comply with all applicable Federal, State and local laws, regulations, and requirements as well as Oakwood’s policies and procedures of job performance.

Requirements

1. Comprehensive knowledge of reimbursement principles including, but not limited to Medicare and Medicaid guidelines.

2. Knowledge of computerized insurance filing.

3. General knowledge of accounting principles.

4. Knowledge of and the ability to read and interpret Explanation of Benefit (EOB) documentation.

5. Fluent in ICD-9 and medical terminology.

6. Ability to examine documents for accuracy and completeness.

7. Extremely detail oriented with strong problem-solving and organizational skills.

8. Ability to understand and apply facility contracts and third party billing requirements.

9. Ability to handle confidential information in accordance with all HIPAA regulations

10. Ability to work in a partnership environment, which fosters teamwork in meeting the mission of Oakwood.

11. Ability to exercise independent judgment and make sound decisions.

12. Ability to multi-task with a high level of accuracy.

13. Takes initiative and demonstrates leadership abilities.

EXPERIENCE AND/OR TRAINING

1. Bachelors degree in Accounting or equivalent experience required.

2. Minimum 2-3 years experience in comparable setting is required. Experience with Medicare and Medicaid in a long-term care facility preferred.

3. Above average ability to use Microsoft and internet-based computer applications.

4. Collection experience a plus.

5. Exceptional customer service skills.