Genesis HealthCare Careers

Medicare and Medicaid Collections (Full Time)

Andover, Massachusetts

Job Description

POSITION SUMMARY: Ensure Medicare and Medicaid claims/bills are produced according to payor and regulatory requirements to assure remittance at first pass: * Improve Quality of Bills Produced prior to formal bill submission * Reduce DSO Resolve issues regarding payment for claims/bills denied for all reasons other than Medical Review. Assist other Team Members in meeting initial bill submission deadlines.

RESPONSIBILITIES/ACCOUNTABILITIES: Prepare Claim Submission: * Enter MDS RUG classification (for Medicare Only) provided by Center. * Perform pre-bill analysis. * Analyze Bill Edit and Exception Report. * Liaise with SNF Customer Service Staff to resolve billing issues; issue/resolve BUGs. * Make hardcopy corrections and update billing system. * Print and File UB92 and Edit Reports per department standard. Edit Claim Submission: * Review and process corrections for claims on hold in FI Systems * Resolve errors/omits/adjustments on FI Systems. * Process non-census adjustments/corrections in billing system. Resolve Claim Denials (excluding Medical Review) * Review Denials and if Medical Denial, notify Reimbursement Department. * Contact payor regarding claims issues, problems or failure to pay. * Influence Payor Representative to review claims during call and communicate status. * Submit supplemental information if required. * Re-submit claims/bills in response to billing errors. * Escalate need for non-Medical Appeals to Specialist, Claims Resolution.



SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. Associate's Degree or 2 or more years experience in billing Medicare is preferred. 2. Healthcare work experience preferred. 3. Enjoys working in high volume environment. JOB SKILLS: Leadership: Demonstrate responsibility in completing daily, weekly and monthly tasks. Cooperate with team in meeting team deadlines. Foster positive working relationships with Center Staff to achieve organizational goals. Financial Management: Knowledgeable in Medicare, Medicaid and/or Insurance Benefit Plans, benefit coordination, payor requirements on submitting claims, and techniques in how to submit a clean claim to ensure payment at first pass. Knowledgeable in processing claims in multiple systems. Understand the unique requirements of different billing systems. Understand factors affecting DSO and Bad Debt e.g. Payor Source Sequencing, Coordination of Benefits, Insurance Requirements, Asset Spend Down, Grant Approval, Appeals/Denials. Business Skills: Demonstrate expert level administrative and organizational skills. Document in writing all actions relating to a specific case. Assure all records are up-to-date and reflect current activity on a daily basis.

Position Type: Full Time
Req ID: 294932
Center Name: Genesis HealthCare