ESSENTIAL DUTIES AND RESPONSIBILITIES

• Serves as a subject matter expert with regards to all aspects of skilled nursing billing processes and the respective biller roles. Maintaining an advanced knowledge of payor updates including Federal and State guidelines, department workflows and resources needed to resolve payor rejections, billing errors and troubleshoot identified denial trends to ensure clean claim rate.

• Knowledgeable with billing software MatrixCare and Epic crossed trained in multiple billing sectors Medicare, Medicaid and Commercial to assist in the Epic biller work queues as needed.

• Knowledge of verifying payor sources

• Knowledge of state and federal nursing home guidelines

• Track facility census information, send census on daily basis

• Complete census, payer builds and payer verification in MatrixCare.

• Review resident accounts and aging reports on ongoing basis.

• Responsible for monthly Medicaid, Medicare, and other insurance billings along with timely follow-up with intermediaries on delinquent payments in coordination with outside billing company

• Monitor and manage the accounts receivable collection process

• Pursue past due accounts persistently and maintain proper back-up documentation.

• Obtain and submit all required documentation to bill third party payers as per program and company guidelines.

• Participate in the resident admission process by providing explanations of the facility's rates, billing cycle and payment terms, including collecting the first month's advance payment upon admission.

• Perform all Month End duties to ensure revenue is booked and billed correctly and timely.

• Maintains personnel and resident files in accordance with all applicable laws and regulations.

• Develops and implements policies and procedures related to Skilled Nursing Facility patient access.

• Implement procedures related to our financial services policy and ensure proper workflows to meet revenue and reimbursement goals.

• Maintain the skilled nursing facility billing program including charge master updates, fee schedule maintenance, user account maintenance, and census event registration maintenance.

• Complete and process audit requests and follow up to ensure that payers receive information needed and that reimbursement is not affected.

• Supervises business office staff. Conduct employee Performance Reviews with subsequent discussion of pertinent review findings and recommendations. Hires partners for Skilled Nursing Facility patient financial counseling, provide training, coaching and disciplining employees; and resolve employee issues.

• Provide a primary point of contact for customer inquiries and work with patients and other customers face to face or by phone. Providing excellent customer service and ensure that employees provide the same positive and helpful image.

• Uses problem solving skills to identify and correct problems before they escalate to larger issues. Collaborate and communicate with other departments to ensure positive interdepartmental interactions.

• Assist with the follow up on patient billing complaints received.

• Maintains professional and technical knowledge by attending educational workshops; review professional publications; establish personal networks and participate in professional societies.

CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service, Meets commitments, Abides by MH confidentiality and security agreement, Shows respect and sensitivity for cultural differences, and effectively communicates information to partners, Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views, Demonstrate a high level of participation and engagement in day-to-day work, Gives and welcomes feedback, Generate suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources, Understands fiscal responsibility Works within approved budget, Develops and implements cost saving measures, contributes to profits and revenue.

EDUCATION AND EXPERIENCE

• Associate's degree in accounting, business management, bachelor's degree preferred. or experience of Business Office Management of at least 2 years, strong multitasking, communication, organizational, and interpersonal skills are critical for a successful career as a business office manager. Experience with MatrixCare software is preferred. Minimum two years' experience in a healthcare environment including supervisory and or training experience.

Knowledge of reimbursement practices for commercial and government payers.

CERTIFICATION/LICENSURE

N/A

ADDITIONAL REQUIREMENTS

Passing the Driver's License Check and/or Credit Check for those positions requiring.

Passing the WI Caregiver Background Check and or IL Health Care Workers Background Check.

Must be able to follow written/oral instructions.

OTHER SKILLS AND ABILITIES

Mathematical Skills - Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills - Excellent oral and organizational skills. Ability to read, analyze, and interpret general business periodicals and technical manuals. Ability to effectively present information and respond to questions from managers and other departmental personnel.

Reasoning Ability - Strong problem solving skills. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills - To perform this job successfully, an individual should be familiar Windows based computer systems. Additional knowledge of automated accounting systems, Plus, Star, and Kronos.

WORK ENVIRONMENT

The noise level in the work environment is usually question, but can reach moderate level.

Occupational Exposure: Category C - All partners in the specified job classification have occupational exposure.

AGE OF PATIENTS SERVED

Pediatric (1 year - 12 years)

Adolescents (13 years - 17 years)

Adult (18 years - 64 years)

Geriatric (65 years and older)

INFORMATION ACCESS

Partner may access financial, strategic, planning, and human resource data, as well as patient care information needed to perform their job duties.

WORK CONTACT GROUP

Patients, families, physicians, vendors, insurance companies, and other Mercy personnel.

SPECIAL PHYSICAL DEMANDS

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

While performing the duties of this job, the employee is regularly required to sit, use hands to operate a keyboard repetitively, talk, and hear. The employee is occasionally required to stand; walk, reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must frequently lift and or move up to 10 pounds and occasionally lift and or move up to 25 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus, particularly as it relates to computer screens. Manual dexterity is needed to operate computer and telephone systems. May have prolonged sitting, talking or hearing. Must be able to read, write and speak English.

LEVEL OF SUPERVISION

Responsibilities include interviewing, hiring, and training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems, employee adherence to annual education and certification requirements

SUPERVISES

Supervisory responsibilities are conducted in accordance with directives of management, the organization's policies, and applicable laws.