Performs responsible accounting duties which may include any of the essential duties noted below encompassing the general areas of billing to clients, guarantors and third party payers for charges on services rendered from the CTC Facilities (Nicolet Psychiatric Center, CTC Outpatient Clinic, Bay Shore Village Nursing Home and Bay Haven CBRF) and/or Human Services programs; collection of payments from clients, guarantors and third party payers; admission paperwork for outpatient and inpatient clients; and payer credentialing of clinical staff. Position duties may include, but are not limited to, financial transactions in the billing, accounts receivable, admissions and collections area. This work requires independent judgment, initiative, and specialized knowledge to carry out established procedures and apply government regulations. Responsible for maintaining knowledge in admissions, billing and collection rules, regulations and accounting procedures while completing work accurately and on a timely basis.
Verifies client payer and demographic information on admissions in the billing system making any necessary corrections, using appropriate means to accurately collect client information prior to billing.
Edit and correct errors on claims in billing system to prepare for claims submission.
Ensure proper signed releases have been obtained prior to submission of claims.
Create and transmit third party payer claims electronically through billing system and/or other electronic billing software within department.
Review remittances for accuracy on the reimbursement amount and complete follow up on denials or rebills.
Correct rejected claims and resubmit to payer, or complete requirement for submission of appeals and retro reviews as needed.
Submission of claims to secondary and/or tertiary coverages.
Follow up with third party payers when no response is received from a submission.
Provide information and answer questions received by payers, clients, social workers and guarantors.
Monitor the need for prior authorizations; execute the initial procedures to obtain the authorization; and complete follow up procedures to ensure proper authorization has been obtained.
Calculate adjustments, refunds and initial refund requests when needed.
Maintain confidentiality of client and business information.
Completes and maintains necessary documentation according to applicable requirement, codes and policies.
Responds to client questions regarding individual billings, payments and account balances.
Assists with functions in the billing computer system; testing of upgrades and other duties as assigned by supervisor.
Scans miscellaneous documents and reports.
Completion of clinical staff credentialing packets for billing payers required for proper reimbursement.
Serves as relief operator for switchboard/receptionist.
Assists ABC Supervisor and/or Accountant Supervisor on various duties to complete claims and collections on services provided through county programs.