Perform diverse billing, collections, accounting, and administrative duties to maintain, bill, and collect patients’ and residents’ accounts and receivables.  Services billed include Hospice, Personal Assistance, and Home Care (Medicare) . Insurances billed include Medicare, Medicaid, state Provider Direct for Aging Service Access points (ASAPS), private pay, managed care, and commercial plans.  Duties include account set-up, maintenance, and management, claim preparation, submission, and collection to industry standards utilizing Meditech hospital information system and paper and electronic claims processing to payors, collections, resolution of issues, and streamlining and improvement of systems and processes.  Requirements include five to ten years of related experience, proficiency with PCs and systems, analysis and basic math skills, and excellent attention to detail.  Experience with Medicaid, Medicare, and/or third party billing and collections, and the Meditech information system, is preferred.  Train new staff as directed.

Hybrid work schedule

Core Competencies:

• Initiative: Willingly seizes or creates opportunities to improve current & future business Performance.
• Results Orientation: Focuses on delivering superior performance by setting and achieving stretch goals.
• Organizational Know-how-understands and uses formal structure, important relationships and culture within HSL and with external customers to accomplish work objectives and outcomes.
• Impact and Influence: Persuades, convinces, and enlists others to support and adopt a course of action or direction in support of organizational goals.
• Customer Service Orientation: Takes personal responsibility for understanding the real and underlying needs of customers’ and anticipating and meeting their expectations to establish viable, long-term relationships.
• Teamwork and Collaboration: Works effectively within a team, group and across the organization and accomplishes tasks and desired results while behaving constructively as opposed to separately and competitively.
• Interpersonal Sensitivity: Increases understanding of others by noticing, interpreting and anticipating feelings and concerns: respects, values and uses individual differences to generate new opportunities and enhance solutions.
• Building People Capability: Develops and empowers others to ensure a ready and skilled supply of talent to meet future business needs.
• Communication: Absorbs, comprehends and exchanges information with others, enhancing mutual understanding of ideas, issues and desired action.
• Technical Expertise: Uses and Expands technical body of knowledge to continuously improve work deliverables, share technical information with others, and establish leading technology practices with the organization.
• Innovation and Creativity: Develops, implements, sponsors or supports new and improved methods, procedures, products, processes, solutions, etc. to improve performance.

Qualifications

• Five years of related experience required/preferred
• Proficiency in PC/Excel/Word, basic math skills, attention to detail, analytic ability, organization skills, and maturity are required
• Outpatient or hospital billing experience preferred. Meditech systems experience preferred.  MassHealth, Medicare, Insurance billing and collections experience preferred.

Physical Requirements

• Normal office work requirements
• Sitting for long periods of time
• Standing & Walking
• Lifting 1-10 lbs
• Carrying 1-10 lbs
• Typing

Position Responsibilities:

• Admissions:  Assist with the admissions process – prepare for and process new admissions, collect initial payments, and explain procedures and answer questions of patients and families.
• Admissions:  Submit Notice of Election forms to Medicare for new admissions for Hospice.  In addition, submit Notice of Admission forms to Medicare for Home Health.  Often these forms must be submitted on the weekend to ensure timeliness. .Time sensitivity must be accepted by Medicare within 5 days.  Requires ensuring that clinical documentation and Certificate of Terminal Illness are completed timely by department.
• Admissions:  Ensure that Medicare eligibility and state insurance information is accurate.
• Ongoing account management:  Monitor accounts for changes, verify Medicaid approvals/PPA breakdown checking for accuracy of financial information and taking corrective action when amounts are not correct, and maintaining the accuracy of insurance payors Meditech. 
• Ongoing account management:  update PPA for nursing home patients.
• Quarterly – Credit Balance reporting for both Home Health and Hospice. In Connex within one month after the end of each quarter.
• Ongoing account management:  Prepare and process in a timely manner Medicare and other insurance updates for Home Health, Hospice, and Personal Assistance.
• Ongoing account management: Prepare and process Hospice Medication and Durable Medical Equipment. Work with vendors for timely submission and accuracy.
• Ongoing billing and collections:  Prepare and submit monthly billing and claims submission to Medicare, Medicaid, Private Pay and Commercial payors, for all service venues
• Ongoing billing and collection:  Interact with Medicare, Medicaid, and state ASAPs along with the Personal Assistance department to resolve authorization and and coverage issues; utilize online sites and systems of Medicare Medicaid Provider Direct and Insurance Companies to automate and streamline the submission, management, and payment of claims.
• Ongoing Billing and collections:  Obtain needed claim information from systems and other departments such as Admissions, Quality, and other ancillary areas to prepare or correct claims.  Use systems and technologies to manage flow of information and identify any issues with processes.  Coordinate with Fiscal staff, Information Technology, and other departments to identify and pursue opportunities to improve and streamline information flow and efficiency of collections.
• Ongoing Billing and collections:  Follow up on all claims for review of suspended or denied claims, correct and resubmit.
• Ongoing Billing and collections:  Maintain tickler file and accurate notes in Meditech on follow up activity, maintain systems to manage status and identify issues requiring follow up or management attention.
• Ongoing Billing and collections:  collect each claim and account to bring to zero balance and meet collection and cash flow targets, identifying any issues and potential opportunities for improved processes.
• Ongoing Billing and collections:  Review and work Accounts Receivable Trial Balance and account agings to identify, analyze, and resolve unpaid or underpaid claims, determining reasons and taking appropriate steps to resolve the payment issues.
• Ongoing Billing and collections:  Process, post and analyze checks and electronic remittances from patients, Medicare, Medicaid, and ASAPS insurances, identifying and resolving denials and differences between expected and actual payment.
• Ongoing Billing and collections:  Manage and reconcile cash receipts and balance to cash journal with accounting
• Other related duties as required.