JOB SUMMARY

Under the general direction of the  Director of Business Services and Business Services Manager , the Nursing Home Financial Advisor will perform accurate/timely filing of initial insurance claims and secondary claims, follow up of claims not paid to assure payment to the hospital and/or affiliated entities to maintain adequate cash flow and accounts receivable balance, in accordance with JCAHO, federal, state, and local guidelines, organizational and departmental policies and procedures. Communicates with medical staff, other departments, and outside agencies while maintaining confidentiality. Position requires self-motivation, creativity, and capabilities to function in a semi-autonomous role within a fast-paced and dynamic environment.

STANDARDS OF PERFORMANCE

1. Manage billing office workload to assure accuracy and timeliness of claims processing and maintain proper cash flow and Accounts Receivable balance

a) Submit primary and secondary claims daily

b) File appeals timely

c) File Medicaid applications and follow up timely

d) Process patient/insurance refunds timely

e) Post patient/insurance payment daily

f) Enter department charges daily

g) Work Age Trial Balance report monthly

1. Carefully review and verify all claim form data for accuracy of charges and demographic information before billing.
2. Review all remittances from payors to monitor for accuracy of payments, calculations of discounts, etc.
3. Review all Medicare/Medicaid and commercial denials for corrections and/or office adjustments.
4. Ensures adherence to proper infection control, OSHA and safety standards.
5. File secondary insurances on claims after primary insurance payment received within a timely manner of primary payment being received.
6. Review, monitor and process credits from credit printout daily, weekly, or monthly.
7. Monitor Medicaid/Medicare and commercial claims daily or weekly to eliminate denials due to timeliness, etc.
8. Contribute to the effective operation of the facility by demonstrating dependability in job performance.
9. Demonstrates ability to use all channels of communication to address inter-and intra- department concerns, problems, and conflicts.
10. Assesses situations requiring intervention or follow-up and refers, if necessary, to appropriate department and/or Business Office Manager.
11. Demonstrates a cooperative working relationship with other departments and team members
12. Demonstrates a positive approach in interaction with all individuals.
13. Required to have at least one hour or one class session of training/education on compliance and or coding per quarter.
14. Performs other duties as assigned by Business Office Manager.
15. Participate in in-services, continuing education seminars and workshops as mandated by facility or Business Office Manager.
16. Other duties not assigned by Business Office Director.

Minimum Level of Education: Education level equivalent to completion of high school.

Formal Training: Skill and experience in planning, organizing, implementing, facilitating, verbal and written communications. Must possess basic typing skills such as; the ability to manage cash and give change and use proper telephone etiquette.

Licensure, Certification, Registration: None required. CPAR preferred. Formal classes in Medical Office Procedure and Nursing Home billing are helpful.

Work Experience: Two years of billing/collection experience in the healthcare field. Intermediate computer skills with word processing and spreadsheet capabilities.