1 Director of Resident Benefits and Payments - Full-Time 1st Shift Job in Milwaukee, WI
North Shore Health Care, LLC is Hiring a Director of Resident Benefits and Payments - Full-Time 1st Shift Near Milwaukee, WI
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Summary/Objective:
Responsible and accountable for the successful management of Private collections and Medicaid eligibility results for assigned areas of responsibility. Supports an environment that promotes a high level of customer service to families, residents, and facility personnel by communicating timely to residents and families regarding benefits and payment expectations.
Essential Functions:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • Reviews Admission Financial Documents for a viable payer source. Communicateswith the facility on missing orincomplete financial documents. • Reviews Financial System Payer Tree set up for all new admissions and communicates with facility on corrections needed. • Communicates with the resident/responsible party benefits available and paymentresponsibility as well as enrollment in RFMS Direct Deposit/Direct Debit. • Verifies resident financial resource limit via the financial worksheet and initiates the Medicaid application process if Medicaid is primaryor secondary payer and not eligible for benefits on admission. • Assists withcompletion of the Medicaid application process including application submission,obtaining supporting documentation, advising on reduction of assets to qualifyfor state Medicaid program. • Contacts county intake workers for application status andfollows up monthly, OR as frequently as needed (and allowed by caseworker) in high-risk cases. • Communicates determination of eligibility (approval or denial) to CBO biller, facility ED/BOM. • Follows the Collections Policy when initiating collection of unpaid Private receivables. • Communicatesprogress and continuing collection obstacles to Senior Director,Executive Directors, and Vice Presidents of Success, verbally and /or inwriting. • Communicate/partner with VPS, Sr. Directorand ED as needed on all high-riskaccounts to identify action needed. • Communicates with Legal Intake for accounts needing placement. • Responsible for the Month End Close Process for assigned areas ofresponsibility. • Provides continual guidance and assists with performanceimprovement plans as neededto strengthen skills and correct performance weaknesses of Business Office Managers. • Assist with training of Business Office personnel on processes, procedures, and systems. • Assist with the selection of new Business Office Managers. Safety o Knows and follows North Shore rules, regulations,and policies o Follows North Shore dress and hygiene policies o Demonstrates proper use of equipment. Reports equipment needs or repairs o Follows North Shore smoking policies o Reports and documents any incidents or accidentsof residents, staff, or visitors to the appropriate North Shorepersonnel o Reports all hazardous conditions/equipment to Supervisor o Uses required protective equipment (as needed during facility visits) o Follows infection control standards, policies, and procedures Resident Rights o Knows Resident Rights o Maintains confidentiality of resident/patient and employeeinformation Helps the residents/patients exercise and/or protect their rights HIPPA o Uses and/or discloses only minimum amount of Protected Health Information necessaryto complete assigned tasks o Follows and adheres to North Shore Healthcare's policies and procedures implementing HIPPA requirements for the privacy and security of protected health information. o Reports all suspected violation of company's HIPAA policies or procedures to CenterPrivacy Designee Work Environment/Physical Requirements The responsibilities of this position may involve travel, physical activities including standing,lifting (up to 50 poundsunassisted), bending, stooping, pushing, pulling, and twisting. All employees of nursing homes may berequired to provide lifting and transfer assistance to residents. Lifting and/or transferring some residents will require use of alifting device and /or assistanceof other staff.
Required Education and Experience
• Bachelor’s degree inaccounting , healthcare administration or business management, or equivalentprofessional level knowledge and workexperience in a related field. • Minimum of three years ’ experience in healthcare billing, collections and I or accounts receivable. • Minimum of two years ’ experience supervisory and I or management experience. • Comprehensive knowledge of health insurance plans, entitlement programs, including eligibility and coverage criteria, application / enrollmentprocedures, pre-authorizations and certification requirements, coordination ofbenefit rules and billing procedures. • Fundamental understanding of automated billing systems. • High level of professionalism and leadership ability. • Strong interpersonal skills , abilityto encourage open communications, foster cohesive working relationships and cultivate a team-orientedoffice environment. • Ability to audit patient accounts, assess accuracy and collectability of account balancesand initiate appropriate collection actions. • Strong organizational skills,including the ability to prioritize and manage multiple tasks. • Excellent communication and training skills. • Basic understanding of Excel and Word. • Ability to maintain regular attendance
Skills, Knowledge and Abilities:
Outcome driven.Effective team player. Ability to multi-task in a fast paced environment. Highpersonal values, integrity, and ethical standards. Excellent interpersonal andoral and written communication skills with an ability to interact withmulti-level professional partners and disciplines. Firm working knowledge ofconcepts, practices and procedures and ability to use in varied situations.Basic computer skills with ability to learn new company applications.
Other Duties
Please note this job description is not designed to coveror contain a comprehensive listing of activities,
duties or responsibilities that are required of theemployee for this job. Duties, responsibilities and
activities may change at any time with or without notice.
Job Summary
Full Time
$123k-156k (estimate)
05/15/2023
08/21/2024
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