Business Office Manager for Skilled Nursing/Rehab facility

Responsible for the follow-up activity and resolution of outstanding accounts on the billing system that includes: processing of all third party denied claims, physician appeals, and electronic claim submission rejections. Process for resolution on all outstanding claims.Review accounts to determine trends and ultimately prevent claim denials, as well as provide on-going analysis of accounts receivable.Responsible for responding to self pay patient and insurance inquires regarding… Show more Responsible for the follow-up activity and resolution of outstanding accounts on the billing system that includes: processing of all third party denied claims, physician appeals, and electronic claim submission rejections. Process for resolution on all outstanding claims.Review accounts to determine trends and ultimately prevent claim denials, as well as provide on-going analysis of accounts receivable.Responsible for responding to self pay patient and insurance inquires regarding account balance on the provided billing system.Reviewing provider contracts to make sure they were applied correctly to billed claims.Responsible for coordinating the billing and collection activities, the production of AR trial operating reports, and the identification of system and clinical registration, charge entry problems and coding problems. Working collaboratively with other members of management to find solutions, create policy and monitor for successful resolution.Identifying and reviewing claims and trends and escalating to appropriate stakeholders.Responsible for implementing changes needed to comply with changing third party rules and requirements.Responsible for coordinating the timely and accurate responses to patient and internal physicians/hospitals.Responsible for increase of Revenue of outstanding AR.Educate physicians and hospitals along with Office managers on appropriate billing, coding methods and payer policies for clean claim payments Show less

Responsible for all insurance billing – Medicare, Medicaid, Managed Care, as well as third party billing.Maintain aging AR; make collections calls to ensure the accounts receivable are collected in a timely manner.Taught the set up and maintenance of financial files for residents, billing, admission papers, state and Medicare reimbursement documents, coordinated and collected accounts receivable and past due accounts.Reviewed payment policies and procedures with the new admissions… Show more Responsible for all insurance billing – Medicare, Medicaid, Managed Care, as well as third party billing.Maintain aging AR; make collections calls to ensure the accounts receivable are collected in a timely manner.Taught the set up and maintenance of financial files for residents, billing, admission papers, state and Medicare reimbursement documents, coordinated and collected accounts receivable and past due accounts.Reviewed payment policies and procedures with the new admissions and their responsible parties.Reviewed with BOM completed receipt records, posted deposits, cash receipts, batch listing, researched/prepared/posted adjustments call in deposits and enter census into HPAS.Prepared billing for agencies, Medicare, veterans and other billing agents.Reviewed provider contracts and made sure they were applied correctly to billed claims.Traveled to different facilities as needed for the resolution of outstanding accounts.Collected on outstanding accounts to clean up AR by inquiries, appeals and grievances.Reported weekly findings on troubled facilities to corporate office. Show less

Successfully reviewed provider appeals, complaints and grievances regarding medical claims, provider and facility contracts and member benefits.Coached new Resolution Analysts on processing and reprocessing of medical claims, reviewing of internal policies, provider contracts and facility contracts.Provided customer service on the phone, regarding medical claims, appeals, and member benefits.Reviewed insurance policies to determine appropriate coverage.Applied knowledge of… Show more Successfully reviewed provider appeals, complaints and grievances regarding medical claims, provider and facility contracts and member benefits.Coached new Resolution Analysts on processing and reprocessing of medical claims, reviewing of internal policies, provider contracts and facility contracts.Provided customer service on the phone, regarding medical claims, appeals, and member benefits.Reviewed insurance policies to determine appropriate coverage.Applied knowledge of contracts, and or insurance laws. Applied oral and written communication techniques.Maintained records, reports and files.Proofread printed and written materials.Recommended claim actions.Applied knowledge of medical terminology.Applied correct grammar, punctuation and spelling to letters and correspondence.Examined files and documents to obtain information.Reviewed data on insurance applications and policies.Translated foreign claims and contacted overseas providers and or facilities for proper payment.Reviewed operative reports for additional payment on claims.Applied customer service techniques.Used computer to enter, access and retrieve data. Show less