Reprices on a weekly basis medical claims (CMS 1500) submitted by outside providers based on the Medicaid fee schedule. Maintains and updates log on a regular basis for all medical claims processed. Ensures medical claims have proper approval (Medical Director) and accurate date of service (WFS) prior to processing.
Maintains and updates monthly spreadsheet of inpatient and outpatient medical claims and ambulance accruals for internal and external audit purposes. Prepares month-end accrual of outside appointments. Works closely with the Clinic to ensure accuracy of month-end list.
Maintains and updates the Medicare Days monthly report for the annual Medicare Cost Report.
Maintains and updates monthly the Uninsured days report for the annual AHCA Medicaid disproportionate share reporting and audit.
Bills Medicare for ancillary services (laboratory, rehab and X-ray) on a weekly basis using the Medicare DDE system. Works on Medicare B denials on a monthly basis and resubmits claims if necessary. Updates monthly denials report.
Reviews Lab Corp and Allied Xray monthly invoices to identify patients with Medicare benefits and notifies vendors to bill Medicare. Reviews Medicare denials and processes invoices for payment if needed. Works closely with service provider and resolves issues timely.
Maintains Medicare D spreadsheet for payments received from insurance providers. Scans all checks for filing and sends copies to DCF. Updates spreadsheet for check copies received from DCF.
Completes month-end report of Medicare B and D collections.
Keeps up-to-date with Medicare and Medicaid rules and regulations.
Downloads annual Medicare B and Medicaid fee schedule from Medicare and Medicaid websites.
Resolves all billing issues with payer or service providers.
Prepares the monthly financial folders of new admissions. Files TPQY, Form 280, SSA correspondence, etc in the Person Served folder. Keeps the financial folders organized by separating discharged Persons Served from the active file.
Sends out the DCF Form 280 to Person Served family member or guardian to be completed for billing purposes.
Applies for SFSH to become Social Security representative payee for delinquent Persons Served. Completes the forms and meets with physician and Person Served to sign the documents (SSA 787) to be sent to Social Security.
Runs the monthly admissions and discharges report from WFS and files report in an organized manner for Medicare/Medicaid reporting purposes.
Runs the Persons Served insurance benefits report from WFS. Ensures that insurance benefits information are accurate. Notifies Social Services Benefits Coordinator when discrepancies are found.
Handles all collection letters addressed to the hospital. Researches collection issues and responds to senders in a timely manner. Processes collection letters addressed to Persons Served and determines appropriate action necessary.
Assists in third party billing and Medicaid ICP billing. Covers for Billing Coordinator when she is on vacation.
Assists in month-end closing. Prices out Food Services raw food supplies for month-end physical inventory. Prepares and completes report timely.
Collects weekly cafeteria cash and prepares monthly sales report.
Files all correspondence and financial reports in an organized manner.
Assists in the annual audit of both external and internal auditors.
Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.
Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.
Must be alert at all times; pay close attention to details.
Must be able to work under stress on a regular or continuous basis.
Perform other duties as assigned.