Hospice - Billing Accounts Specialist
High school or GED
This is a PRN position (as needed - 4 hours per week) This position is accountable to perform departmental patient accounts functions. This position must demonstrate a commitment of quality service to patients, the public, and Associates. The incumbent in this position will be responsible for compliance with all federal and state laws and regulations governing the privacy of patients' protected health information.Essential Functions & Responsibilities:Interfaces courteously and effectively with all departmental customers to provide assistance. Responsible for daily operations and maintenance of Patient Accounts and ensuring timely billing and collection of accounts receivable. Monitors payer communications/updates (e.g., "CMS"). Demonstrates a thorough knowledge of insurance guidelines including Medicare and Medicaid regulations related to HHPPS/CGS, Home Health Managed Care and Hospice. Generates timely and accurate routine end of month statistical reports and special ad hoc reports in support of ongoing operations and performance improvements. Provides feedback to all appropriate Home Health & Hospice Managers on appropriate payer issues and trends. Audits explanation of benefits. Serves as back-up to print ADR's when applicable. Collaborates with medical records on outstanding orders/485s/HPOT. Complete appeals and adjustments as needed for claims processed by payers incorrectly. Monitor 100% of Explanation of benefits from all payers to ensure negotiated reimbursement is received. Performs other duties as assigned.Qualifications:High School Diploma required. At least one year experience of collections or patient registration required, preferably in a healthcare setting. Certified Revenue Cycle Specialist (CRCS-I) certification or related industry certification required within one year of hire date.Excellent customer service and telephone skill. Computer skills necessary for data management, one to two years progressively responsible data processing experience preferred. Knowledge of methods, practices, and terminology used in medical, financial, and statistical work. Accounting or record keeping experience in a medical setting desirable. Demonstrated written & verbal communications skills. Demonstrated proficiency in current personal computer applications, i.e. Microsoft Office applications.Addendum:Additional Duties for Billing Accounts Specialist – Updated December 2016:1. Responsible for daily operations and maintenance of Patient Accounts and ensuring timely billing and
collection of accounts receivable to include:
a. Monitors status of CGS claims for (RTP/ADR)-CWF for benefit periods/open to other agency/MSP
b. Downloads electronic remittances, monitors insurance or payer acceptance and rejections.
c. Prints MCR and Managed Care payer remittances.
d. Previews and processes claims (to include all unbilled claims) in claims Alert and Late EMC.
e. Monitors claims/accounts that are outstanding.
f. Transfers claims from within A/R system to the appropriate claims system.
g. Performs editing procedures on all claims prior to submission.
h. Submits claims to third party payers or to patients/guarantors including correspondence.
i. Reviews admission registers with MCR.
j. Reviews EOB's and completed follow up as needed, to include appeals.2. Completes assigned A/R reports within designated time frame.3. Monitors Medicare return to provider (RTP) file to resolve any outstanding issues and identify
additional documentation review as needed. 4. Performs system end of month closing and back-up activities for Home Health and Hospice.5. Submits OASIS data to Centers of Medicare/Medicaid Services (CMS). Processes
corrections/submissions and researches CMS final validation reports.6. Extracts hospice invoice information from Procare system. Reviews invoices for hospice patients and
imports into Netsmart for insurance billing.7. Reviews and processes hospice invoices from multiple sources. Submits
invoices to Accounts Payable
for payment to provider(s) based on Medicare allowables or contract amounts. Enters charges into
internal Accounts Receivable system for submission on hospice claim form.Additional Duties for Insurance Verification/Authorization, Cash Processing, and Face-to-Face – Updated December 2016:Initiates and maintains follow up on face-to-face documents to the certifying physician for signature. Verifies patient demographics, insurance, and other information as needed. Verifies eligibility for Medicaid products as appropriate.Utilizes EHR systems and partners with outside facilities to obtain all clinical documentation support the face-to-face regulatory requirements set by CMS.Obtains initial and subsequent authorization for all non-Medicare payers prior to services being rendered.Partners with physician offices, MWHC Care Management department, and the Physician Help team to educate and improve communication on current regulatory requirements and changes to Home Health face-to-face documentation.
Assists Intake Specialists, clinicians, and billing department with communicating patient/guarantor financially responsibility as needed.
Audits patient admissions and monitors appropriate reports to ensure timely notification and insurance verification processing. Downloads electronic remittances and collaborates with departmental Associates on outstanding billing issues. Performs daily and end of month closing and back-up activities and makes bank deposits. Responsible for prompt and accurate entry of payments and adjustments into the collection system for Home Health and Hospice and for preparing daily cash reports in a timely and accurate manner. Files and retrieves source documents from various sources, including but not limited to: paper files, microfiche files, and on-line files. Participates in Performance Improvement activities for Insurance Verification and Cash Processing.Identifies and recommends process improvements within the registration process. Additional Duties for Intake Specialist – Updated December 2016:Utilizes a centralized intake function to optimize referral satisfaction.Provides verification of insurance and obtains authorization of insurance for Home Health and Hospice services. Makes initial contact with insurers for benefit coverage and requirements needed for reimbursement on an on-going basis.Provides follow-up to convert inquiries into requests for services. Reviews all inquiries and investigates for follow-up phone calls within designated time frame.Performs follow-up activities in support of patient care. Obtains physician verification for the primary physician on the Home Health or Hospice referral.Performs patient registration and insurance verification duties. Works with patient or guarantor to verify patient demographics and insurance information. Verifies with the referring physician to ensure the information on the referral is accurate.