Homecare Reimbursement Specialist- Homecare Finance

Homecare Reimbursement Specialist- Homecare Finance

Coordinates patient accounts from time of prior authorization to point of bill payment or referral to collection. Processes all billing for home health agency to appropriate agencies, including Medicaid and self-pay; computes contractual adjustments, maintains related files and records. Maintains current knowledge of changes in billing requirements and regulations. Assists client in resolving billing problems.

Schedule: (Contingent , Non-Exempt)

Hybrid

Location:

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Reviews insurance/primary payor information for completeness.
• Collects and documents ongoing payer source information.
• Verifies prior authorization requirements from the public and private insurers.
• Obtains initial and ongoing prior authorizations for all service lines according to payor specific requirements.
• Performs data entry of initial and ongoing patient information and authorizations within acceptable timeframe according to NCHH policy and procedures.
• Reviews statements and claims for reasonability and completeness. Identifies and obtains necessary additional information. Rebills accounts when necessary. Identifies billing problems and recommends solutions to the NCHH Finance Manager and family as appropriate.
• Prints, posts, and processes all patient bills, correlating the required documentation for submission of bills for reimbursement in a timely manner.
• Posts payments to accounts upon receipt.
• Generates all billing, cash receipts, write-offs and related reports for monthly accounting review.
• Provides follow-up rejection/denials/unpaid bills in a timely manner.
• Monitors accounts. Processes refunds, refiles and corrects accounts, identifies and resolves billing problems, consults with representatives from reimbursement agencies.
• Notifies NCHH Finance Manager of inquiries/complaints pertaining to patient accounts from patients, insurance companies, collection agencies, legal representatives and NCH services.
• Maintains current knowledge of changes in billing requirements and regulations; monitors changes in Medicaid, BCMH and Medicare regulations and billing requirements; files procedure updates; and revises billing procedures.
• Verifies prior authorizations prior to the billing for NCHH services.
• Bills and prepares ledger sheets for ODH Waiver Program billing.
• Maximizes reimbursement through verbal and written communications, education and counseling of families, professional providers, case managers, and home care personnel.
• Follows NCHH collection procedures for account follow-up for all unpaid claims.
• Assists, as appropriate, in complying with applicable: federal, state and local laws; Medicare / Medicaid Conditions of Participation; JCAHO standards; State of Ohio Waiver regulations; and any other appropriate accrediting or regulatory body.
• Participates as directed in marketing efforts and community endeavors.
• Participates in drills (including fire, bomb, tornado, weather disaster, community disaster, etc.) and ICES Rounds and follow up, as directed, to ensure the safety of patients, families, staff, students, vendors, visitors to the NCHH building, etc.
• Promotes, models and participates in NCH and NCHH customer service initiatives; fosters patient / parent / caregiver, payor, provider and other community relationships through using effective communication and collaboration skills; and openly and willingly provides NCH staff and managers with customer feedback, in an appropriate and goal-oriented way.
• Actively participates in NCHH continuous quality and performance improvement activities under the direction of the QI Coordinator and respective manager(s) (including event tracking and reporting, patient case conferences, performance improvement teams, customer satisfaction surveys, utilization review activities, etc.
• Conducts self in a manner that supports good patient relations and projects a professional image consistent with NCH and NCHH standards.
• Maintains at all times the rights of the patient / family regarding confidentiality of the medical record, according to policy.
• Supports the philosophy, mission, policies, procedures, standards, and strategic goals of NCH and NCHH; participates, as directed, in short and long-range planning and NCHH strategic goal development, implementation and evaluation.
• Manages own learning and skills related to existing and new computer systems, as appropriate, including becoming proficient in NT / Outlook and Microsoft Office 2010.
• Participates in general and department staff meetings, committee work and other related activities as assigned.
• Performs other duties as assigned, including the assumption of new duties commensurate with the growth of the agency.

KNOWLEDGE , SKILLS AND ABILITIES REQUIRED:

Education:

• High School diploma required

Required & Preferred Experience:

• Minimum two years experience billing public and private insurers for medical services using computerized billing system required, with experience related to Homecare services preferred.
• Knowledge of and previous experience using Microsoft Excel, Word, and ability to operate 10-key adding machine required.

Minimum Physical Requirement:

• Sitting Frequently (34 - 66)
• Talking on the phone / in person Frequently (34 - 66)
• Typing on a keyboard Frequently (34 - 66)
• Standing / walking Occasionally (00 - 33)
• Lifts objects weighing up to 30 pounds Occasionally (00 - 33)

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.

EOE M/F/Disability/Vet