Diakonos Group, LLC
We are driven by our commitment to bring positive change to our profession and expect excellence and progressive leadership from our employees. We build a work environment where each individual is valued and respected and has the opportunity for personal and professional growth. We will always strive to be the difference makers and a guiding light in our profession.Purpose of Your Job PositionThe primary purpose of your job position is to assist in collections of payments from all payers, including, but not limited to, Managed Care, Co-Insurance and Medicaid. Manage and assist the Medicaid Billing Specialist and Business Services Associates with the Medicaid Pending Process, from application, estimating vendor pay and approval processes for all Medicaid billing locations that include skilled nursing facilities and applicable assisted living facilities.DUTIES AND RESPONSIBILITIESEssential Functions* Audit and correct all accounts where payment does not equal the revenue booked, resulting in a debit or credit balance for Medicaid, Managed Care and Co-insurance payers.* Assist the Medicaid Billing Specialist in training and assisting Business Services Associates in the Medicaid Pending Process.* Upload or assist in sending documentation to payers on audit requests after the documentation is gathered by our Medicare Nurse Consultant.* Assist Medicare Nurse Consultant in auditing PCC to make sure correct documentation is in our system to support billing and send those results to the facilities to correct.* Responsible for adding billing notes regarding status of unpaid balances.* Ensure documentation of all actions relating to a specific case. Assure all records are up-to-date and reflect current activity on a daily basis.* Review Medicaid Pending Logs weekly.* Collect ancillary bills from facilities monthly and upload it to the shared drive.* Responsible for maintaining current knowledge of regulations, industry trends, current practices, and new developments regarding credit issues and the long term care industry.* Ensure knowledgeable in Medicaid, benefit coordination, payor requirements on submitting claims, and techniques in how to submit a clean claim to ensure payment at first pass.* Understand factors affecting DSO and Bad Debt e.g. Payor Source Sequencing, Coordination of Benefits, Insurance Requirements, Asset Spend Down, Appeals/Denials.Safety and Sanitation* Report all unsafe/hazardous conditions, defective equipment, etc., to your supervisor immediately.* Follow all established safety procedures and precautions when operating office equipment.Equipment and Supply Functions* Ensure nursing supervisory supplies have been replenished in work areas as necessary. Report equipment/supply needs to your supervisor.* Ensure that work/assignment areas are clean and equipment and supplies are properly stored before leaving such areas on breaks, end of day, etc.Budget and Planning Functions* Report suspected or known incidence of fraud relative to false billings, cost reports, kickbacks, etc.Resident Rights* Maintain the confidentiality of all resident care information including protected health information. Report known or suspected incidents of unauthorized disclosure of such information.* Ensure that resident's rights to fair and equitable treatment, self-determination, individuality, privacy, property, and civil rights, including the right to wage complaints are followed.* Knock before entering a resident's room.Other Duties* Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.Working Conditions* Works throughout the assigned area (i.e., offices, facilities, etc.).* Moves intermittently during working hours.* Is subject to frequent interruptions.* Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances.* Is subject to hostile and emotionally upset residents, family members, personnel, and visitors.* Communicates with facility personnel and support team members.* Works beyond normal working hours, on weekends and holidays, and in other positions temporarily, when necessary.* Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.).* Attends and participates in continuing educational programs.* Is subject to injury from falls, burns from equipment, odors, etc., throughout the workday, as well as to reactions from dust, disinfectants, tobacco smoke, and other air contaminants.* Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses.* May be subject to the handling of and exposure to hazardous chemicals.Education* Must possess, as a minimum, a high school education or its equivalent. Associates Degree preferred but not required.Experience* Minimum two year billing experience in a LTC/SNF environment or in a Central Billing Office for LTC Company* Working knowledge of Oklahoma Medicaid Programs as they operate in SNF environment* Working knowledge of Managed Care and Co-Insurance in a SNF environment.* Experience using Word, Excel. Experience using PCC is helpful, but not required.Specific Requirements* Must be able to read, write, speak, and understand the English language.* Must be proficient in Word and Excel.* Must have clear written and verbal communication skills.* Must be able to maintain confidential information.* Most possess good time management skills.* Must maintain excellent attention to detail.* Must be a supportive team member, contribute to and be an example of team work and team concept.* Must possess the ability to make independent decisions when circumstances warrant such action.* Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the public.* Must possess the ability and willingness to work harmoniously with other personnel.* Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents.* Must not pose a direct threat to the health and safety of other individuals in the workplace.* Must be able to work independently.Physical and Sensory Requirements(With or Without the Aid of Mechanical Devices)* Must be able to move intermittently throughout the workday.* Must be able to speak and write the English language in an understandable manner.* Must be able to cope with the mental and emotional stress of the position.* Must be able to see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met.* Must function independently and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.* Must meet the general health requirements set forth by the policies of this facility, which include a medical and physical examination.* Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility.* Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet.* May be necessary to assist in the evacuation of residents during emergencies.