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Spartanburg Regional Healthcare System Financial Specialist (Located in Beaumont Mills Admin Office) in Spartanburg, South Carolina

Position Summary

The Specialist is responsible for assisting revenue cycle and accounting operations for our Long-Term Skilled Nursing facilities. This position will provide direct supporting clerical assistance in billing processes related to Medicaid Pending and Medicaid Approved accounts receivable, the facility Resident Trust Fund, Resident Billing activities, month end close and billing processes, working directly with the Manager – Financial SNF, Director of Revenue Cycle – Post-Acute Division, Billing Specialist, and other accounting related functions, as well serving as a resource to the SNF facilities. This position provides clerical support to the Manager – Financial SNF and the Skilled Nursing Facilities related to the day-to-day details and tasks relating to the responsibilities mentioned above. This position reports directly to the Manager – Financial SNF and works closely with the nursing home departments and administration, Billing Specialist, as well as other Revenue Cycle and Accounting staff.

Minimum Requirements

Education

  • High School Diploma or equivalency

    Experience

  • Must have had at least 5 years Long Term Care billing and/or business office experience in a Skilled Nursing Facility

    License/Registration/Certifications

  • N/A

    Other Knowledge, Skills, and Abilities

  • Must have good knowledge of South Carolina Medicaid Pending, Billing and Recertification.

  • Must be familiar with multiple payer (Medicare, Medicare Advantage, Commercial and Secondary/Supplement) requirements and regulations for admissions, billing, reimbursement, and appeals processing .

  • Knowledge of Resident Trust Fund processes and requirements.

  • Must have solid Microsoft Office skills with a focus on Excel and Word.

  • Excellent communication skills and the ability to courteously interact with residents, their families, facility Administrator and staff and multiple departments within SRHS.

    Preferred Requirements

    Preferred Education

  • Healthcare related Associates or Bachelor’s degree

    Preferred Experience

  • 5+ years billing experience in a Long-Term Care billing and/or business office setting.

  • Medicare, Medicaid, Medicare Advantage and Commercial billing processes and requirements.

    Preferred License/Registration/Certifications

  • Certified Revenue Cycle Associate (CRCA)

    Core Job Responsibilities

  • Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.

  • Must possess a good working knowledge of the UB04 claim form and the data elements/field data required.

  • Must possess the ability to work in different systems including claims eligibility, online payer claims system, case management as well as all AR management systems.

  • Must have working knowledge of registration, payment posting, error correction and other billing functions.

  • Manage time and job responsibilities to meet monthly goals

  • Work with facilities to submit proper Medicaid 181 documentation for Medicare spell of illness, admission or transfer from another facility, change in status, discharge or termination, etc.; as well as Level of Care to ensure Medicaid, Medicaid Managed payers or Hospice are appropriately paying monthly rates.

  • Ensure billing processes are complete and accurately generated for all Medicaid, Medicaid Managed Care and Hospice agencies.

  • Follow up with Medicaid Provider Service Center and Hospice agencies to ensure any obstacles to payment for residents are being corrected and made.

  • Resolve Turn Around Document (TAD), remit and other errors to ensure payment is made by Medicaid or Medicaid Managed Care payers.

  • Prepare and submit Medicaid 181 for Medicare Deductible and Coinsurance portions and ensure a remit with Remark Code 678 has been received. Once received, will complete Medicare Bad Debt Logs.

  • Assist facilities in verifying insurance eligibility and benefits.

  • Submit potential facility admissions insurance information to Manager for financial clearance.

  • Receive, deposit and post Resident Trust Fund checks, as well as payment disbursements and conveyance of funds upon discharge or death.

  • Generate and mail Resident Trust Fund statements.

  • Conduct Family Conferences as needed.

  • Complete Annual Rep Payee Certs and Annual Medicaid Recerts.

  • Generate and mail monthly Resident Billing Statements.

  • Complete cash posting, charge batch entry and deposit preparation and submission for LTC Nursing Facilities.

  • Assist Manager with denials, appeals, refunds, and Quarterly Credit Balance reports as directed.

  • Complete month end Stats, expense review, and any requested financial research.

  • Assist in budget preparation, reporting and research as directed.

  • Assist in all clerical duties to support all of the Revenue Cycle and Accounting duties required for our Long-Term Care SNF facilities.

  • Assist in accurately updating patient demographics, insurance registration information, verification of insurance, etc.

  • Work closely with multiple departments to obtain necessary information to resolve outstanding AR.

  • Accurately update and verify insurance records as needed to correct outstanding accounts.

  • Processing of all refunds or credit reversals in a timely manner as defined within the departmental credit/refund policy/procedures.

  • Complete special projects as assigned by Manager, Director and/or other members of Management.

  • Other duties as assigned.

  • Always exhibit excellent professional communication and customer service skills while working with coworkers and employees in multiple departments within the system.

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