Financial Representative 2 (765266)

QUALIFICATIONS:

• Bachelor’s degree or a combination of education and experience with MA billing requirements.
• Working knowledge of Medicaid & Medicare billing.
• Experience in health care accounts receivable and cost reporting beneficial.

MAJOR POSITION DUTIES AND RESPONSIBILITIES:

• Maintain working knowledge of MA regulations governing nursing facilities
• Perform financial reviews and financial follow-up reviews according to established policies driven by federal and state regulations.
• Conduct specialized financial reviews as assigned
• Provide technical assistance to skilled nursing facilities on billing requirements.
• Perform review of resident personal care funds/trust accounts to assess appropriateness of expenditures and presence of the nursing facility fiduciary control
• Compare MA Status Change Report with nursing facility records for correct payor source ad accuracy of census data
• Analyze nursing facility accounts receivable to identify MA overpayments
• Manage the collection of overpaid MA claims
• Perform post review functions and reports including the monthly Recovery Report
• Prepare and coordinate all necessary documentation to organize and perform the financial review
• Compile and analyze information following a review with designated nursing facility staff to present the results of the financial review
• Analyze documentation to identify recurring trends and concerns of nursing facility billing practices
• Perform Entrance and Exit Conferences with designated personnel of assigned skilled nursing facility
• Responds to phone calls, emails, and other correspondence from providers, representatives, and other stakeholders. This requires extensive knowledge of regulations, policies and procedures, and the ability to provide instruction to providers on how to complete enrollment applications and forms accurately. Must have the ability to effectively communicate information to others.
• Reviews documents for adherence to Departmental policy, standards, and guidelines, including current Medical Assistance regulations and CMS waiver guidelines where applicable.
• Develops and maintains relationships with appropriate agencies, such as the Department of Health, Office of Developmental Programs, Area Agencies on Aging, or other stakeholders regarding ongoing certification or licensure requirements.
• Maintains the appropriate databases for data input, research, and analysis, updating, and reporting purposes.
• Process claims adjustments according to established procedures
• Monitor the status of all submitted claim adjustments
• Attend hearings for appeal and defend the financial review findings
• Other duties as assigned

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com