Trust, engagement, competence, respect and passion – these are the values under which North Shore Healthcare operates every day. Our dedicated team of professionals strive to deliver quality care to our residents and their families. We are one of the leading employers and providers of post-acute care in the Midwest and we are seeking exceptional individuals to join our team. If you value being a leader, working in a progressive environment and having opportunities to grow in your career, North Shore Healthcare is the Right Choice for you.
Summary/Objective : Perform all duties related to the timely and accurate billing and collection of government and private insurance receivables as assigned..
Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Reviews, prepares, and submits primary, secondary, and supplemental insurance claims as assigned.In charge of any A/R adjustments and corrections needed.
• Follow-up on all assigned outstanding accounts until balances are resolved.
• Utilizes company approved system for documentation and follow-up on all assigned claims.
• Manages receivables assigned by identifying issues and taking appropriate action to resolve.
o Corresponds with payer as needed to provide required documentation.
o Identifies and researches credit balances per policy and payer requirements.
• Identifies facility adverse trends causing non-payment or late payment of claims
o Contacts facility and provides appropriate training to resolve issue.
o Escalates issue to supervisor if problem persists, or if necessary, to address a probable globalissue.
• Participates in AR reviews.
• Provides guidance to the Director by identifying adverse trends and performance issues with staff.
• Educates staff in n billing, claims processing, follow-up and collections
• Attends selected management meetings
• Proactively reviews data to identify trends and takes corrective action if needed.
• Problem solves/recommends corrective action on accounts
• Supervisory responsibilitieso Assumes a managerial role in billing and collections of project payers.
o Responds to new hires’ questions regarding billing requirements, internal processes, etc.
• Other duties as assigned.
• Safety
o Knows and follows center ruleso Follows center dress and hygiene policies
o Demonstrates proper use of equipment. Reports equipment needs or repairs
o Follows center smoking policieso Reports and documents any incidents or accidents of residents, staff or visitors to theappropriate center personnel
o Reports all hazardous conditions/equipment to Supervisoro Performs duties, which may include transportation of residents, as assigned in CenterDisaster Plano Uses required protective equipment
o Follows infection control standards, policies and procedures.
• Resident Rights
o Knows Resident Rights. Helps the residents/patients exercise and/or protect their rights
o Reports resident/patient complaints to managemento Maintains confidentiality of resident/patient information
• HIPAA
o Follows and adheres to Center’s policies and procedures implementing HIPAA requirements for the privacy and security of protected health information
o Uses and/or discloses only minimum amount of Protected Health Information necessary to complete assigned tasks
o Reports all suspected violation of company’s HIPAA policies or procedures to CenterPrivacy Designee.
Work Environment/Physical Requirements
The responsibilities of this position involve significant physical activities including standing, lifting (up to 20 pounds unassisted), bending, stooping, pushing, pulling and twisting.
Required Education and Experience
• High school diploma (or GED), or
• Minimum of five (7) year experience in health care insurance billing, preferably long-term care.
• Comprehensive knowledge of commercial insurance and managed care plans, including basiccoverage models, billing requirements, subscriber and provider responsibilities, and coordination ofbenefits (COB) rules.
• Exposure to automated billing.
• Ability to manage, analyze, and reconcile billing and payment detail.
• Strong organizational and communication skills.
• Basic understanding of Excel and Word.
• Exposure to PCC system preferred.
• Exposure to Zirmed and Ability Ease All Payer software preferred.
• High School diploma or equivalent• At least 3 years of demonstrated success as an administrative assistant
• Computer proficiency with Microsoft products
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.