Position Summary

The Financial Manager (SNF) is directly responsible for all Long-Term Skilled Nursing Facilities (SNF) Revenue Cycle and Accounting related functions for our Long-Term Skilled Nursing Facilities (SNF), such as, but not limited to: daily billing and Revenue Cycle accounting tasks, Medicaid Pending and Medicaid Approved accounts, oversight and reconciliation of the facility Resident Trust Fund, Resident Billing processes and month end close. This position works closely with the Director of Revenue Cycle – Post Acute Division, Long Term SNF Billing team, and serves as a Revenue Cycle resource to the facilities and supports all revenue cycle responsibilities. This position is responsible for the development, implementation and measurement of strategic departmental goals related to the assigned Revenue Cycle and Accounting responsibilities, as well as all other duties identified and assigned. The Manager provides management and oversight of all clerical duties to support all Revenue Cycle and Accounting functions required in our Long-Term Skilled Nursing facilities. This position reports directly to the Director of Revenue Cycle – Post Acute Division. Revenue Cycle and Accounting functions required in our Long-Term Skilled Nursing facilities. This position reports directly to the Director of Revenue Cycle – Post Acute Division.

Minimum Requirements

Education

• High School Diploma or equivalency

Experience

• Must have had at least 5 years Long Term Care billing and/or business office experience in a Skilled Nursing Facility

License/Registration/Certifications

• N/A

Other Knowledge, Skills, and Abilities

• Must have good knowledge of South Carolina Medicaid Pending, Billing and Recertification.
• Must be familiar with multiple payer (Medicare, Medicare Advantage, Commercial and Secondary/Supplement) requirements and regulations for admissions, billing, reimbursement, and appeals processing.
• Knowledge of Resident Trust Fund processes and requirements.
• Must have solid Microsoft Office skills with a focus on Excel and Word. Excellent communication skills and the ability to courteously interact with residents, their families, facility Administrator and staff and multiple departments within SRHS.

Preferred Requirements

Preferred Education

• Healthcare related Associates or Bachelor’s degree

Preferred Experience

• 5 years billing experience in a Long-Term Care billing and/or business office setting.
• Medicare, Medicaid, Medicare Advantage and Commercial billing processes and requirements.

Preferred License/Registration/Certifications

• Certified Revenue Cycle Associate (CRCA)

Core Job Responsibilities

• Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.
• Must possess a good working knowledge of the UB04 claim form and the data elements/field data required.
• Responsible to bill and follow up all assigned services within timely filing requirements as defined by departmental goals and insurance guidelines.
• Must possess the ability to work in different systems including claims eligibility, online payer claims system, case management as well as all AR management systems.
• Must have working knowledge of registration, payment posting, error correction and other billing functions.
• Manage time and job responsibilities to meet monthly goals
• Responsible for assisting facilities in reviewing financial approval for new admissions.
• Responsible for all clerical duties to support all of the Revenue Cycle and Accounting duties required for our Long-Term Care SNF facilities.
• Responsible to accurately update patient demographics, insurance registration information, verification of insurance, etc.
• Responsible to assist Director of Revenue Cycle with needed charge additions and corrections.
• Responsible for Medicaid Pending, Medicaid and Resident Balance/Self Pay balance Accounts Receivable.
• Responsible for eligibility research and follow up, Level of Care Follow Through and submission of 181 Documentation to Medicaid and/or Hospice Agencies.
• Responsible for submission of Resident Status Changes, Coinsurance, Patient Monthly Liability changes and other 181 documentation submission to SC Medicaid Provider Liaison Center.
• Responsible for working with facility Administrator to oversee and manage the Resident Trust Fund, including bank statement reconciliation, statements, and conveyance of funds.
• Responsible to review and resolve all daily claim errors based on coding/billing guidelines.
• Collections of all applicable outstanding claims by direct payer contact, utilization of payer websites, and through EDI/Claims systems.
• Responsible to complete all error corrections and insurance updates to the facility claims to resolve outstanding denial/issue preventing payment by assisting Business Office as needs arise.
• Research and resolve all payments issues/errors for Medicaid and Resident balances.
• Responsible for managing all retro-authorizations for multiple payers by working with facility and ensuring needed forms are sent in a timely manner.
• Work closely with multiple departments to obtain necessary information to resolve outstanding AR.
• Update and verify insurance records as needed to correct outstanding accounts.
• Identify all denial trends and provide education of steps to prevent future avoidable denials.
• Communicate all denial trends and denial increases to direct supervisor/manager to positively affect the volume of denials.
• Initiate/manage all insurance appeals in a timely manner as directed.
• Organize the workflow to ensure that denials are worked according to departmental policy and standards.
• Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeliness and accuracy of response.
• Processing of all refunds or credit reversals in a timely manner as defined within the departmental credit/refund policy/procedures.
• Responsible for all government monthly credit reporting preparation and requirements.
• Responsible to research and complete a detailed analysis of all payer variances based on contract information available.
• Must have the skill set and understanding of payer and government payer contracts/schedules to confirm expected reimbursement amounts are correct.
• Work closely with other departments on revenue integrity issues including variance contract build issues, charging issues, A/R type issues and other items as defined.
• Complete special projects as assigned by Director and/or other members of Management.
• Other duties as assigned.
• Always exhibit excellent professional communication and customer service skills while working with coworkers and employees in multiple departments within the system.