Medicare Financial Specialist
The Medicare Financial Specialist is responsible to the Financial Controller. Must communicate well and work closely with residents, families, third party payers, outside agencies and other staff members.
- Develops and maintains current, thorough knowledge of Medicare and other third party payer rules and regulations as applicable to Hale Makua. Stays abreast of any Medicare regulatory changes affecting Hale Makua’s billing and A/R processes. Researches opportunities to expand knowledge base including attending classes or seminars, reviewing government releases or reports from outside Medicare consultant.
- Serves as the Business Office’s super-user and project lead for the billing components of the Accounts Receivable software. Keeps abreast of system changes, understanding and implementing updates. Understands and demonstrates proficiency in Hale Makua operational procedures. Recommends structure changes or improvements to the billing processes. Trains others on the use of system.
- Performs internal control audits on inpatient and outpatient billing systems. Assists Controller in the reporting of findings to the Compliance Committee.
- Audits outgoing bills for accuracy before submission to residents and third party payers.
- Reviews Daily Census Report to ensure accurate entries by Admissions, Nursing Staff, and third-party vendors. Translates and verifies accurate and timely transfer of data to Billing and Accounts Receivable software.
- Reviews all payer-related and level of care changes for accurate transmission into Accounts Receivable software. Uploads therapy imports into AR system and verifies all payers, units, and RUG levels. Enters all charges and G-Codes into AR system as necessary.
- Obtains RUGS report updates and inputs assessments periodically.
- Ensures that statements and claims are accurate, and are submitted in a timely and orderly manner. Follows up and corrects and outstanding or rejected claims as necessary.
- Analyzes and processes rebills to adjust for discrepancies and changes. Initiates payment vouchers to refund overpayments and resolves past due accounts.
- Identifies and resolves all SNF Consolidated Billing issues to ensure Hale Makua’s compliance with Medicare regulations.
- Negotiates claim denials, etc. with third party insurers as needed. Responsible for communicating information to Account Clerk, Admissions Department, Nursing, Health Information Management (HIM), etc.
- Maintains, monitors and reports according to set billing cycle metrics.
- Ensure bills are processed in accordance with department minimum billing cycle standards. Follows up with rehab vendor and HIM regarding any outstanding invoices and coding errors.
- Ensures Medicare Credit balance report is submitted in a timely manner.
- As Medicare payment occurs, identifies and submits billing for secondary claims that do not automatically crossover to secondary insurance.
- Participates in the month end close process by ensuring that billing is completed timely and reconcile specific elements within A/R.
- Participates in monthly account receivable (A/R) reviews.
- Identifies and creates batches for necessary billing adjustments.
Full-time. Work Schedule: Monday to Friday, 8 am to 4:30 pm.
- Graduate of an accredited school of business or equivalent combination of education and on-the-job experience.
- At least two years previous experience in health care claims filing and collection, preferably in long-term care. An equivalent combination of education and experience may be substituted for stated minimum requirements.
- Must have knowledge of the billing and collection processes and general knowledge of accounting in an accounts receivable system.
- Must possess fundamental understanding of Windows-based computer system and be able to use Microsoft Office applications (including but not limited to Excel, Word and Outlook).
- Good organization and verbal/written communication skills.
- Demonstrate sensitivity, tact and diplomacy in interactions with others.
- Adequate mathematical, grammar, filing and documentation skills to perform work assignments.
- Ability to function without close supervision.
- Demonstrate flexibility, personal integrity and ability to work cooperatively and effectively with others.
Non-Bargaining wages based on education and relevant work experience.