Ensure claims/bills are produced according to payor and regulatory requirements to assure remittance at first pass; business goals are:
* Improve Quality of Bills Produced prior to formal bill submission
* Reduce DSO
May assist Billing Specialist Team in meeting initial bill submission deadlines.
* Process Primary and Secondary Commercial Insurance claims, e.g. Long Term Insurance, Motor Vehicle, Workmen's Compensation,
* Liaise with Center Staff to ensure verifications, authorizations, and documentation requirements meet payor requirements for claim submission
* Prepare final bill for submission, e.g. UB92 and include supporting documentation using prescribed format.
* Follow up on any/all unpaid claims.
* Maintain records, files and logs of claim status or other billing information as directed.
* Interact with Third Party Payors as required to obtain payment for pending claims.
* Prepare adjustments/corrections to Commercial Bills.
* Refer problems or rejected claims to Specialist, Claims Resolution.
* Assure accuracy of demographic information in the Billing System to ensure accurate billing and prompt payment.
Resolve Claim Denials:
* Contact payor regarding claims issues, problems or failure to pay.
* Assure claim is complete in order for carrier to process promptly.
* Submit supplemental information if required.
* Influence Payor Representative to review claims during call and communicate status.
* Re-submit claims, bills in response to billing errors.
* Review Denials and re-submit bill.
* Process adjustments/corrections for Private Pay and Commercial claims/bills.
* Process non-Medical Appeals and Timely Filing Appeals to resolution.
* Notify SNF staff of customer loss of payor status and timely processing of payor sequence.
* Perform follow-up activities to assure commercial insurance payments are received.
Position Type: Full Time
Req ID: 317661
Center Name: Genesis HealthCare