SUMMARY  

Responsible for assisting daily work for Medicare Accounts Receivable (A/R), and patient insurance eligibility/authorizations  

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Assists in supervision of Revenue Cycle (RC) staff to ensure that all benefits/eligibility, authorization and billing are processed timely/accurately for Hospice. 
2. Assist in monitoring progress with eligibility coordinator (EC) staff on timeliness of patient payor entry prior to admission and status changes billing updates. Review of benefit period set up to ensure compliance. Review transfer in patients and discharge reason information for accuracy.
3. Monitor daily notice of election (NOE) front end work with EC staff and ensure submission of NOE/NOTR remains timely within 5-day rule. Follow through to paid status and monitor NOE return to provider (RTPs) and address any overlap issues as they occur.
4. Assist in pre-billing Medicare reviews in electronic medical record (EMR) and report to RC Director as needed. (open clinical visits, validation holds) 
5. Ensure Medicare claims are processed timely and review reasons for error and claim holds.
6. Review claim RTP/denial weekly. 
7. Monitor Medicare open accounts and discuss with RC Director any follow-up efforts being made, not allowing uncollectable accounts to remain in AR.
8. Research Medicare credit balances monthly to resolve. Notify RC Director if timely takeback is not possible of true credit balances. 
9. Maintains Medicare Hospice A/R aging to reduce total AR and resolve current follow up issues. Working with other agencies to resolve overlap issues timely. 
10. Assist in review of financial assistance applications as needed, for percentage of charity to be applied and communicate with staff/family. When needed assist with charity write off and post back adjustments in system.
11. Assist as needed to create Nursing Home Room & Board invoices or process invoices received from facilities billing offices prior to claim submission to ensure TennCare pass through billing and compliance. Forward completed invoice to Accounts Payable for payment processing. 
12. Assist with new EMR setup to gain knowledge to oversee the administration of software setup related to billing compliance. Jointly with RC Director, collaborate with Information Technology and software vendors. 
13. As needed to assist in communication with credentialing company (Teleios (TCN) to maintain mal-practice application and forward Certificate of Insurance documents to Human Resources & TCN. 
14. Stays current with CMS regulations as related to claim process. 
15. Other duties may also be assigned.

EDUCATION and/or EXPERIENCE

College accounting preferred; five to eight years’ experience or equivalent combination of education and experience. Experience in medical accounts receivable preferred, including responsibility for daily operations of the department. Knowledge of Medicare DDE System.

CERTIFICATE, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.