What are the responsibilities and job description for the PATIENT SERVICES REPRESENTATIVE - INSURANCE BILLING & COLLECTIONS position at Catholic Health Services?
Summary & Objective
Responsible for the billing and collections timely follow up of all assigned Medicaid claims for Nursing Home and Hospital in a cost effective and efficient manner. Successful accounts receivable management is predicated on working closely with nursing home and hospital business office and admissions staff, as well as the various governmental regulatory agencies (i.e., DCF).
Essential Functions
- Billing of all claims via the SSI software (and when appropriate web portal or paper billing). This includes editing billing data, and reconciling all bills via KNS.
- Follow up on all outstanding claims greater than 30 days.
- This includes the successful resolution of all claims in a timely and cost effective manner.
- Run all A / R aging reports after KNS month end to use as an A / R management tool.
- Complete A / R spreadsheets and be prepared to review details with management at scheduled monthly review meetings.
- On going management of detailed A / R trial balance for Medicaid / Medicaid MMC / MMA payers to ensure proper timeliness of billing claims, appropriate documentation (i.e., authorizations, NOCA's, etc.) are received and included on claims, appeals are submitted within appropriate timeframe. This includes the overall compliance with all Medicaid (State) regulatory guidelines.
- Follow up and facilitate resolution of all denied claims. Including identifying and communicating to Director root causes and trends resulting in denials (CBO; Facility; etc.)
- Obtains Medical Records from appropriate facilities for the purpose of appealing denied claims.
- Ensure that most recent NOCA's are updated in the KNS database and maintained for future audits.
- Maintain close working relationship with facility counterparts in business office, admissions office, case management office, medical records office, etc. to ensure effective revenue cycle management.
- Utilization of all departmental system tools (i.e., KNS; Trace; SSI; etc.). In addition identify and communicate any and all systemic issues that may result in payment delays, underpayments, lost revenue, etc.
- Billing and follow-up for Medicare co-insurance billing to Medicaid and / or Medicaid MMC / MMA payers for SNF and all other lines of business (i.e., Hospital; Outpatient and Clinics).
Other Duties
Supervisory Responsibility
Physical Requirements
Disclaimer
The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.
EEOC Statement
CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Requirements
Knowledge & Experience Requirements
