Third Party Reimbursement Specialist

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The Central Office of a nation wide family of Continuing Care Retirement Communities is seeking a Third Party Reimbursement Specialist. This position will provide third party billing services to one or more campuses of Covenant Living. This position will prepare, bill and monitor claims for Medicare Part A, Medicare Part B, Medicare Managed Care (HMO) and coinsurance. In addition, this position will be responsible for overseeing and coordinating the response to the Fiscal Intermediary (FI) or Medicare Administrative Contractor (MAC) to all Additional Development Requests (ADRs) from Medicare or other insurance companies. This position is expected to deliver outstanding accounts receivable results and customer service while maintaining a working relationship with the on-site campus personnel.

• In this role, the Third Party Reimbursement Specialist will:

  • Obtain monthly reports from the assigned campus(es) in order to determine and carry out the billing needs;
  • Prepare, review and submit individual resident claims for Medicare Part A, Medicare Part B, coinsurance, Medicare Managed Care (HMO) or Private Fee-for-Service(PFFS) and others as needed;
  • Rely on Medicare’s cross-over billing when available, and collaboration with Healthcare Billing Assistant for follow-up with a paper claim, only when claim is outstanding after 60 days;
  • Track, generate and submit Benefit Exhaust and No-Pay claims for assigned campus(es);
  • Track, generating and submitting denial claims, denial for insurance claims or if special requirements exist at assigned campus(es);
  • Submit and monitoring of all resident claims on a timely basis;
  • Record of Medicare payments in the Vision system after Electronic Remittance Advice (ERA) import; Upload all Medicare Part A and B claims to UB Watch and use resulting data to ensure accurate billing.
  • Propose adjustments and write offs, per CL Policy 5201, to ensure accurate representation of the aging at any point in time;
  • Review of Medicare Part B therapy log, as needed, to ensure proper diagnosis code information is entered under Medicare Part B payer in Vision.

  The ideal candidate will have:

  • Bachelor of Arts or Science degree in Accounting, Healthcare or related field and/or 5 years of long term care billing experience, required.
  • Good inter-personal relationship skills and the ability to deal well with others and handle a variety of routine tasks and responsibilities in a professional, prompt manner.
  • Excellent organizational skills, initiative and good judgment, accuracy and attention to detail.
  • Ability to work collaboratively and effectively with campus staff via telephone and email.
  • Tact and posses excellent communication skills (written and verbal, English skills required) to effectively Genuine compassion for senior adults and the disabled, project a friendly character, support customer service and team concepts.

$26.92 - $36.23 per hour

Reasonable Pay Estimate

A reasonable estimate of the pay range for this position is $26.92 - $36.23 per hour. There are numerous factors taken into consideration in determining the actual offered rate of pay, including but not limited to: job-related qualifications, experience, skills, education, geographic location, and consideration of internal and external equity.

For full time employees, we offer a generous benefits package that includes:

• Medical, dental and vision insurance

• Employer paid group term life and disability

• Paid Time Off (PTO) & six paid holidays

• 403(b) with a 3% employer match

• Fitness center use at most facilities.

• Various voluntary benefits:

• • Life, AD&D

  • Tuition assistance and scholarships

  • Employee assistance program

  • Legal services, home/auto insurance, discount purchasing program

  • Pet Insurance

For more information about Covenant Living and CovenantCare at Home, please visit www.covliving.org or www.covenantcareathome.org.

Covenant Living and CovenantCare Home Health and Hospice are equal opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin or ancestry, age, disability, marital status, pregnancy, protected veteran status, protected genetic information, or any other characteristics protected by local laws, regulations, or ordinances.