Purpose :

The primary purpose of this job is to assist in maintaining business office records in accordance with federal and state guidelines, as well as in accordance with our established policies and procedures, to assure that a complete business office program is maintained.

Requirements

• 2-3 years of experience in a healthcare billing, preferably in long term care environment
• Ability to understand and implement healthcare reimbursement, billing and accounting principles
• Ability to understand, control and track direct spending and labor budgets
• Commitment to maintain a good working rapport with inter-department personnel, residents’ families as well as other departments within the facility and also with outside agencies.
• Create and maintain an atmosphere of warmth, personal interest and positive emphasis, as well as a calm environment.

Preferred:

• Previous experience in healthcare strongly preferred.
• Experience in long term care experience preferred
• Bachelor’s or Associate’s degree from accredited college with specialization in business or accounting preferred

Administrative Functions:

1. Quality Monitoring and Quality Assurance Functions:
a. Participate in the facility Quality Assurance Committee and process; b. Maintain a quantitative/qualitative audit/monitoring process; c. Collect data and report findings to QA Committee; d. Conduct routine monitors (admission, MDS, concurrent, acute problems, and discharge) and perform focused reviews of problem areas, QA concerns, Quality Indicators and survey issues.

2. Health Information Management Functions:
a. Maintain security of health information systems and business office records. Assure physical protection is in place to prevent loss, destruction and unauthorized use and disclosure of both manual and electronic records. b. Assure systems are in place to maintain confidentiality of both manual and electronic health information; c. Manage the release of information functions for the facility, including review and processing of all requests for information.

Maintain facility policies and standards of practice to assure release of information requests are appropriate and meet legal standards; d. Maintain a forms management system for development, review, and reproduction of facility forms. Maintain a master forms files/manual;

3. Records Management Functions:

Work in conjunction with the admissions coordinator to ensure completion of all aspects of the admission process;

• Complete the appropriate information in the census register (if applicable);
• Complete and file as applicable the master index information (computerized or manual);
• Initiate the in-house medical record and in-house overflow file, prepare labels, etc.;
• Complete admission checklists and admission monitors; a. During the Resident’s stay:
• Ensure that each resident has a current payer source.
• Act as a liaison to the billing company, forward required documentation,
• Complete non-covered services forms and maintain records for easy retrieval, forward to the billing company;
• Coordinate with Social Services regarding completion of applications, e.g. Medi-Cal redetermination papers and other needed required documents;
• Act as a liaison between Nursing, ancillary disciplines and the Health Information Department;
• Contact physicians or departments as needed when signatures or information is needed before records can be completed;
• Ensure that physicians are completing Medicare certifications/re-certifications;
• File all incoming clinical information in the in-house records on a daily basis; b. Discharge:
• Record appropriate discharge information in the census register (if applicable);
• Monitor and Follow-up on discharge record deficiencies including monitoring/mailing information to the physician for completion as applicable. Maintain discharge record control log. File discharge record in incomplete clinical record file until complete and then, file the discharge record in the complete file;

4. Billing Management Functions:

• Understand all aspects of the billing process for all payer types.
• Review & Mail out Private Statements.
• Post ancillary charges
• Participate in tripe Check for Medicare and Managed Care Billing
• Understand the collecting process for all payers’ types.
• Communicate with Residents/Family as needed.
• Complete facility statistical reports such as monthly facility statistics, daily census, licensure reports as applicable;
• Communicate with our billing company;
• Communicate with Social Services Office, Medi-Cal and MediCare offices as needed;
• Communicate with Insurance companies, HMOs;
• Communicate with pharmacy, laboratory, X-ray, Hospice companies;
• Participate in meetings and committees such as daily stand-up, administrative, quality assurance/quality improvement, Medicare documentation review.