Billing Followup job vacancy in Logan Health – Jobs in Whitefish, MT

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Job Details
Company Name : Logan Health
Company Location : Whitefish, MT
Job Position : Billing Followup
Job Category : Jobs in Whitefish, MT

Job Description :
Job Description Summary: Is responsible for maintaining good client relations. Processing Medicare, Medicare Advantage and Medicaid claims posting Medicare and Medicaid payments. Filing supplemental claims for patients with secondary insurance policies to Medicare. Maintaining and the testing of new procedures in the Paragon and Relay Health applications. Refunds patients, Medicare, Medicare Advantage, Medicaid and third party claims as applicable.

(Marginal Functions = MF Essential Functions = EF)

Processes Medicare/Medicaid and Medicare Advantage claims in a neat and timely fashion.

Verifies insurance in computer, completing essential insurance fields to ensure the UB04, 1500 and 5010 claims are complete and accurate. (EF)
Submits EMC daily to Medicare/Medicaid and Medicare Advantage programs. Files hard copy or paper claims when unable to send EMC. (EF)
Maintains and provides courteous relations with patient, families, insurance companies and other employees of the hospital. (EF)
Keeps in contact with Discharge Planner on status of patient, having patient sign appropriate forms for swing bed, last covered day, etc. (EF)
Appeals claim when necessary to Medicare, Medicaid, Medicare Advantage and third party payers. (MF)
Reviews late charges daily, sending corrected claims as needed. (MF)
Familiarizes self with Medicare Fraud and Abuse issues and brings forth recommendations when necessary with regards to these issues. (EF)
Familiarizes self with Medicare/Medicaid updates. (EF)
Investigates non-payment of claims. (MF)
Investigates missing charges, submits to supervisor if needed, for further investigation. (MF)

Is responsible for posting Medicare/Medicaid payment as requested by supervisor. Responsible for investigating credit balances and refunding applicable parties.

Posts Medicare/Medicaid payment, adjustment and any non-covered charges on a weekly basis in absence of supervisor. (EF)
Prints payment and adjustment, batches and forwards along with any miscellaneous cash to cashier, in absence of supervisor. (EF)
Copies Medicare payment spread sheets in order to submit claims to supplements. (EF)
Investigates and determines if refund should go back to Medicare, or insurance companies of patients. (MF)
Submits a credit balance list to Medicare on a quarterly basis. (EF)
Submits patient and insurance refunds to supervisor for approval. (EF)
Prints all ERA’s for all LOB’s from clearinghouse and provides to cashier to post ERA’s in Paragon. (EF)
Performs, reviews, prints morning reports from Paragon and Relay Health, disseminating information to applicable parties. (MF)
Responsible for client billing and functions related to client billing. (MF)
Notifies LHW Clinics of payments belong to Clinics. (MF)

Other duties as assigned

Works with Fiscal Services to locate missing remits where money was deposited but not posted to the patients account. (EF)
Works with CMS, HIM on RAC audits. (EF)
Evaluates and considers the need for Lean Processes, Service Orders and overall workflow processes in order to achieve more efficient and streamlined procedures. (MF)
Works closely with PFS Team Lead and Manager to insure new product releases are tested in a timely fashion. (MF)

Compliance Plan and Code of Conduct: LHW is dedicated to the highest ethical standards as it is essential to meeting our commitment to our mission and vision. Individual responsibilities include adhering to our organizational Compliance Plan and Code of Conduct.

Maintains awareness and understands the organization-wide compliance plan. Familiar with and adheres to LHW’s published Code of Conduct which provides guidance and expectations regarding confidentiality, conflict of interest, billing, controlled substances, Emergency Medical Treatment and Labor Act (EMTALA), payments for referrals, gifts, anti-kickback laws, safety and health, waste disposal, and compliance with antitrust laws, advertising and marketing, discrimination, insider trading and government requests. (EF)
Reports any violation or suspected violation of this Code or other hospital policies or procedures to supervisor, Compliance Officer or through the compliance hotline. (EF)
Attends and/or completes mandatory training regarding organizational compliance. (EF)

Education and Experience Requirements

Required : Previous experience processing Medicare and Medicaid claims, posting Medicare/Medicaid payments, verbal and written communication skills; computer and ten-key proficiency and accuracy and data entry skills; and customer service skills.

May Require Skills Testing:

Medical Billing (CMS-1500)

Medical Billing (UB-04)

Medical Billing Knowledge

Medical Claims Processing

Yearly Healthstream testing : HFMA Billing Suite, HFMA Avoiding Claims Denial or equivalent.

Desire : Customer service training

Shift: Day Shift – Variable Hours (United States of America)

Schedule Details:

Please know schedules and shifts are subject to change based on patient care and department/organizational needs.
Logan Health operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Notice of Pre-Employment Screening Requirements

If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:

Criminal background check
Reference checks
Drug Screening
Health and Immunizations Screening
Physical Demand Review/Screening

Equal Opportunity Employer

Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify Human Resources.

Patient Centered Care

Welcome to Logan Health – Whitefish and thank you for your interest in becoming a part of our fascinating team. We believe that everyone who works at Logan Health – Whitefish is a caregiver, regardless of their job description. While Logan Health – Whitefish provides competitive pay and benefits, as well as a comfortable work environment, our employees are motivated by our service commitment to provide quality patient care for our community.

As a Planetree affiliate, we have embraced the philosophy of providing patient-centered care, recognizing diversity and providing exceptional customer service. It was the catalyst for change that resulted in Logan Health- Whitefish receiving national recognition for six consecutive years from Avatar International, Inc. for exceeding patient expectations. We take pride in providing our quality level of service and continuously work to go above and beyond our stellar reputation.

Please take a few minutes to view this informational video for a look into Logan Health – Whitefish.