Supports senior community billing and insurance administration by sending invoices, verifying Medi-Cal eligibility and health plans, requesting long-term care authorizations, entering charges and account updates in PointClickCare, following up on insurer payments, maintaining Excel records, and organizing documentation for audits. The role also requires HIPAA compliance, confidentiality, accurate communication, attendance, and routine office administration.
Schedule Full -Time Monday - Thurs
JOB SUMMARY: Supports Solheim Senior Community (“Solheim”) by assisting with resident billing, insurance eligibility and authorizations, payment follow-up, account updates, and preparation of records for audits.
ESSENTIAL JOB FUNCTIONS:
- Faxes private-pay invoices to long-term care insurers.
- Emails private-pay invoices to residents’ responsible parties.
- Accesses the Medi-Cal website and prints eligibility responses.
- Verifies changes in residents’ Medi-Cal health plans and Share of Cost.
- Enters updated resident account information in PointClickCare (PCC).
- Updates the Dual Eligibles Excel file with changes in Share of Cost, bed holds, and health plans.
- Updates the Medicare Excel file.
- Prints reports, including detailed census and payer setup information.
- Identifies residents who need new long-term care authorizations.
- Requests authorizations from Medi-Cal long-term care insurers and updates PCC with authorization numbers and approval dates.
- Compiles therapy logs, UB-04 detail reports, pharmacy and laboratory invoices, medical supply lists, face sheets, Notices of Medicare Non-Coverage (NOMNC), managed care authorizations, and Triple Check forms for the Triple Check Audit.
- Enters charges in PCC.
- Follows up on payments from insurance companies.
- Organizes resident files in preparation for audits.
- Adheres to payroll policies and properly uses the timekeeping system.
- Maintains regular and consistent attendance.
- Adheres to Solheim’s Compliance Plan and HIPAA regulations.
- Performs other duties as assigned.
POSITION REQUIREMENTS:
EDUCATION/EXPERIENCE:
- High school graduate or equivalent.
- Business office, billing, or insurance experience preferred.
- Knowledge of Microsoft Excel, Microsoft Word, and PointClickCare (PCC).
- Familiarity with copiers, fax machines, and other office equipment.
SKILLS/KNOWLEDGE/ABILITY:
- Desire and ability to work with ill, aged, and disabled persons.
- Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.
- Willingness and ability to follow written and verbal direction in English.
- Willingness and ability to maintain appropriate level of confidentiality and privacy.
- Willingness and ability to interact professionally with all customers, including the ill, aged, disabled persons and co-workers, individually and as part of a team.
- Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
- Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
- Ability to effectively prioritize items/tasks as required.
- Willingness and ability to effectively respond to emergency and/or crisis situations.
- Willingness and ability to take initiative and be a self-starter.
- Willingness and ability to understand and comply with Federal, State, and local regulations.
LICENSURE/CERTIFICATE/TRAINING/ANNUAL REQUIREMENTS:
- Fire Card
- Annual PPD
- Annual physical
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