Patient Services Representative

Summary & Objective

Responsible for the billing and timely follow up of all assigned Medicaid claims for Nursing Home and Hospital in a cost effective and efficient manner. Successful accounts receivable management is predicated on working closely with nursing home and hospital business office and admissions staff, as well as the various governmental regulatory agencies (i.e., DCF).

Essential Functions

• Billing of all Medicaid claims via the SSI software (and when appropriate web portal or paper billing). This includes editing billing data, and reconciling all bills via KNS.
• Follow up on all outstanding claims greater than 30 days.
• This includes the successful resolution of all claims in a timely and cost effective manner.
• Run all A/R aging reports after KNS month end to use as an A/R management tool.
• Complete A/R spreadsheets and be prepared to review details with management at scheduled monthly review meetings.
• On going management of detailed A/R trial balance for Medicaid/Medicaid MMC/MMA payers to ensure proper timeliness of billing claims, appropriate documentation (i.e., authorizations, NOCA’s, etc.) are received and included on claims, appeals are submitted within appropriate timeframe. This includes the overall compliance with all Medicaid (State) regulatory guidelines.
• Follow up and facilitate resolution of all denied claims. Including identifying and communicating to Director root causes and trends resulting in denials (CBO; Facility; etc.)
• Obtains Medical Records from appropriate facilities for the purpose of appealing denied claims.
• Ensure that most recent NOCA’s are updated in the KNS database and maintained for future audits.
• Maintain close working relationship with facility counterparts in business office, admissions office, case management office, medical records office, etc. to ensure effective revenue cycle management.
• Utilization of all departmental system tools (i.e., KNS; Trace; SSI; etc.). In addition identify and communicate any and all systemic issues that may result in payment delays, underpayments, lost revenue, etc.
• Billing and follow-up for Medicare co-insurance billing to Medicaid and/or Medicaid MMC/MMA payers for SNF and all other lines of business (i.e., Hospital; Outpatient and Clinics).

Other Duties

• All other duties as assigned by the Revenue Cycle Manager.

• Maintain your required license, certifications and mandatory skill updates.

• Comply with all policies, local, state and federal laws and regulations.

• Perform other duties as assigned.

Supervisory Responsibility

• No direct reports.

Physical Requirements

• Must be able to lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds, walk, climb stair or ladders, stand on feet for extended periods of time, etc.
• Works in office environment with moderate to loud noise level.
• Subject to frequent interruptions.
• Work schedule may include working beyond typical schedule, including weekends and holidays.
• Hand dexterity required for data entry on keyboard, requiring finger dexterity and eye-hand coordination.

Disclaimer

The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

EEOC Statement

CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Knowledge & Experience Requirements

• High school diploma and two years related experience of a combination of education and training.

• Must be knowledgeable with computers, calculators, system applications, spreadsheets and other related office equipment.

• Must have knowledge of computer office/clinical software

• Must be able to read, write and understand the English language

Notice of AI Use in Job Application Review

As part of our commitment in creating a fair, efficient, and consistent hiring process we may use artificial intelligence (AI) to help our recruiting teams organize, summarize, and analyze information provided by candidates, including resumes, application responses, and other materials submitted during the application process.AI may be used to identify patterns, highlight relevant skills, and experience, and assist in comparing a candidate’s qualifications with the requirement of a specific role. These tools are to improve efficiency and consistency while supporting more informed hiring decisions, which will ultimately be made by the hiring team.