Note: The job is a remote job and is open to candidates in USA. Ohio Living is hiring an Accounts Receivable Coordinator - Third Party Billing to manage billing and collection of funds for patient services funded by Medicare, Medicaid, and other third-party insurance. The role prepares and submits claims, resolves denials and outstanding balances, supports accurate revenue and receivable records, and communicates with sites and insurance agencies.
Responsibilities
- Maintain, obtain, retain and apply knowledge regarding the specific billing requirements for Medicare, Medicaid and all other third-party commercial insurance funding sources
- Prepare and transmit all third party claims electronically using specified software and carrier portals within established monthly billing performance timeframe and by prescribed due dates. This includes billing primary and secondary third party agencies
- Complete all third party triple check forms for every primary claim prior to release of claims on billing due date. This includes compliance related items, eligibility, coordination of benefits, and census accuracy
- Review and balance all assigned ancillary service files provided by various vendors by the prescribed dates for the month end close billing cycle to ensure all ancillary services are captured in billing files to enable accurate claims
- Ensure that all required documents are scanned into the electronic medical record for the date required prior to claims release. Adhere to supervisory internal control review requirements before release of claims
- Check resident census admissions and information changes daily to ensure that proper third party payer was selected by site representatives, as indicated by the facility insurance payer guide, and make corrections when necessary
- Communicate with sites when required precertification, preauthorization, authorization and re-authorizations were not been obtained in order to for appropriate action to occur to minimize uncollectible accounts receivable
- Identify and escalate site or payer related issues to supervisor/manager in a timely manner
- Monitor status of collections and appropriate cash receipt application to correct patient account balances
- Identify denied claims on a daily basis. Research, correct and resubmit claims on a daily basis via prescribed software, third party internet portals, or mail if only option. Escalate any continuing or complicated matters to supervisor/manager for additional attention and potential consultant advisory
- Communicate with third party agencies to facilitate successful correction and payment of claims when necessary. Communicate with site representatives when necessary to assist in resolution of denied claims
- Assemble information to enable responses to additional development requests to support clinical necessity of claims, and for cases where grievance or appeal is appropriate. Communicate with site and corporate representatives as necessary to facilitate responses to third party agencies. Track and report status
- Review third party accounts receivable aging reports to identify outstanding balances and take appropriated action to research and resolve outstanding balances. Goals for overall days in accounts receivable, targeted outstanding balances needing resolution and expecting timing will be established on a monthly basis by supervisor/manager
- Prepare and provide for review and approval all accounts receivable write-off and other types of revenue or receivable balance adjustments as needed with all required supporting documentation
- Identify and notify supervisor/manager of other potential issues through use of various reports that may indicate the need to make revenue, receivable, payer, or rate corrections to ensure that revenue and receivables are recorded accurately and timely
- Identify and offer suggestions pertaining to process improvements
- Communicate collaboratively with the account receivable coordinators – private pay to resolve any common patient/resident receivable matters
- Successfully transition through payer education requirements by pre-determined deadlines, including all payer facility contracting relationships, payer rules and regulations and payer appeals and grievances process
- Participate in recurring team meetings and trainings. Assist and/or be present for site personnel trainings
- Prepares other special reports and performs other tasks or projects as requested and/or required
- All other duties as assigned
Skills
- High school diploma or equivalent required
- Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required
- Must be able to read, write, speak, and understand the English language
- Associate degree in a related field preferred
- Accounting coursework or concentration desired
- Three years experience performing billing operations preferred
- Experience in long-term care, hospital, or other related healthcare accounting preferred
- Experience with accounts receivables analytics preferred
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