Third Party Reimbursement Specialist

About the role

The Central Office of a nation-wide family of Continuing Care Retirement Communities is seeking a Third Party Reimbursement Specialist. This position will provide third party billing services to one or more campuses of Covenant Living. Key responsibilities include preparing, billing, and monitoring claims for various insurance types, responding to Fiscal Intermediaries (FI) or Medicare Administrative Contractors (MAC), and delivering outstanding accounts receivable results and customer service.

Responsibilities

• Obtain monthly reports from the assigned campus(es) to determine and carry out the billing needs
• Prepare, review, and submit individual resident claims for Medicare Part A, Medicare Part B, coinsurance, Medicare Managed Care (HMO) or Private Fee-for-Service (PFFS) and others as needed
• Rely on Medicare's cross-over billing when available, and collaborate with Healthcare Billing Assistant for follow-up with a paper claim, only when claim is outstanding after 60 days
• Track, generate, and submit Benefit Exhaust and No-Pay claims for assigned campus(es)
• Track, generate, and submit denial claims, denial for insurance claims or if special requirements exist at assigned campus(es)
• Submit and monitor all resident claims on a timely basis
• Record of Medicare payments in the Vision system after Electronic Remittance Advice (ERA) import
• Upload all Medicare Part A and B claims to UB Watch and use resulting data to ensure accurate billing
• Propose adjustments and write-offs, per CL Policy 5201, to ensure accurate representation of the aging at any point in time
• Review Medicare Part B therapy log, as needed, to ensure proper diagnosis code information is entered under Medicare Part B payer in Vision

Requirements

• Bachelor of Arts or Science degree in Accounting, Healthcare or related field and/or 5 years of long-term care billing experience
• Good interpersonal relationship skills and the ability to deal well with others and handle a variety of routine tasks and responsibilities in a professional, prompt manner
• Excellent organizational skills, initiative, and good judgment, accuracy, and attention to detail
• Ability to work collaboratively and effectively with campus staff via telephone and email
• Tact and possess excellent communication skills (written and verbal, English skills required) to effectively communicate with stakeholders
• Genuine compassion for senior adults and the disabled, project a friendly character, support customer service and team concepts

Qualifications

• Experience with Medicare billing and reimbursement processes
• Knowledge of healthcare billing software and systems
• Strong analytical and problem-solving skills
• Proficiency in Microsoft Office applications

Skills

• Strong knowledge of Medicare billing and reimbursement processes
• Excellent organizational and time management skills
• Ability to work independently and as part of a team
• Strong written and verbal communication skills

Benefits

• Medical, dental, and vision insurance
• Employer-paid group term life and disability
• Paid Time Off (PTO) and six paid holidays
• 403(b) with a 3% employer match
• Fitness center use at most facilities
• Voluntary benefits such as life, AD&D, tuition assistance, and scholarships
• Employee assistance program
• Legal services, home/auto insurance, discount purchasing program
• Pet insurance

Pay

Compensation Pay Range: $26.92 - $36.23 per hour

Schedule

Full-time position