NH PFS COORDINATOR

The Hospital Authority of Miller County•Colquitt, GA

1d•Onsite

About The Position

JOB SUMMARY: Responsible for compiling itemized nursing home bills, verifying patient and resident insurance coverage and computing patient and resident insurance benefits. Works closely with the Admitting Office, Medical Records and physicians’ office staff. EDUCATION, CREDENTIALS & EXPERIENCE REQUIREMENTS: High school graduate or equivalent. Through understanding of Medicare, Medicaid, HMO’s, PPO’s private insurance companies. GENERAL REQUIREMENTS: Performs all job responsibilities in alignment with the mission and vision of the organization. Performs other duties as required and completes all job functions as per departmental policies and procedures. Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs). Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time. Wears protective clothing and equipment as appropriate. GENERAL SKILLS: Ability to communicate in English, both verbally and in writing. Additional languages preferred. Strong written and verbal skills. Basic Computer Skills WORKING CONDITIONS: General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids, or infectious organisms. May be required to change from one task to another or different nature without loss of efficiency or composure. Periods of high stress and fluctuating workloads may occur. May be scheduled as needed including overtime. PHYSICAL REQUIRMENTS & DEMANDS: Have near normal hearing: Hear alarms/telephone/normal speaking voice. Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors. Have good manual dexterity. Have good eye-hand foot coordination. Ability to perform repetitive tasks/motion. Continuously within shift (67-100%): Standing, Walking. Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry greater than 20 lbs. with assistance. Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry greater than 50 lbs. with assistance, Reaching above shoulder. MISSION STATEMENT: QUALITY HEALTHCARE: In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis and treatment. JOB SPECIFIC COMPETENCIES: Assists with admission process, verifying insurance information. Compiles nursing home bills, completes appropriate forms and submits claims to proper agencies/insurance companies. Submits all new Medicaid applications, collects and gathers all information requested and required for Medicaid approval. Tracks Medicaid pending status weekly and prepares and submits the Medicaid Pending Report. Gathers and completes all information requested and required for Medicaid annual reviews. Tracks (annual review binder) for completing and enters any new liability changes into computer system. Posts ancillary charges daily, processes mail daily, scans as needed daily, posts payments, and prepares deposits daily and takes to banks. Maintains current resident accounts and contact information in the computer system to avoid loss of claims. Always verifies resident account number. Maintains a computer master list of insurance companies outlining correct name and address. Maintains and audits financial files. Admissions to NH - Social Security Rep Payee submission, Disability application done as needed, Georgia Medicaid application - follow up weekly. Medicaid renewals and representative payee reports received and completed. PROFESSIONAL REQUIREMENTS: Follows Code of Conduct policy. Adheres to dress code; appearance is neat and clean. Completes annual educational requirements. Maintains regulatory requirements. Maintains patient confidentiality at all times. Reports to work on time and as scheduled; completes work within designated time. Wears identification when on duty; uses computerized time clock system correctly. Completes in-services and returns in a timely fashion. Attends annual review and/or skills fair and department in-services, as scheduled. Attempts to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees. Complies with all organizational policies regarding ethical business practices. Communicates the mission statement of the organization. GUEST RELATIONS STANDARDS: (All guest relation violations are subject to disciplinary action up to and including termination): Always treat others in a friendly, helpful manner. Refers co-workers to proper sources when unable to provide an answer. Interacts with others in a professional and friendly manner. Takes interest in others and always gives full cooperation to fellow workers. Always maintains an open line of communication with other departments. Thoroughly familiar with the hospital and the services it offers. OTHER: Responsibility to Report: It is the responsibility of every employee of HAMC to comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures. Every employee is help accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected. As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable. OTHER DUTIES: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Requirements

High school graduate or equivalent.
Through understanding of Medicare, Medicaid, HMO’s, PPO’s private insurance companies.
Ability to communicate in English, both verbally and in writing.
Strong written and verbal skills.
Basic Computer Skills
Have near normal hearing: Hear alarms/telephone/normal speaking voice.
Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors.
Have good manual dexterity.
Have good eye-hand foot coordination.
Ability to perform repetitive tasks/motion.

Nice To Haves

Additional languages preferred.

Responsibilities

Compiling itemized nursing home bills
Verifying patient and resident insurance coverage
Computing patient and resident insurance benefits
Assists with admission process, verifying insurance information.
Compiles nursing home bills, completes appropriate forms and submits claims to proper agencies/insurance companies.
Submits all new Medicaid applications, collects and gathers all information requested and required for Medicaid approval.
Tracks Medicaid pending status weekly and prepares and submits the Medicaid Pending Report.
Gathers and completes all information requested and required for Medicaid annual reviews.
Tracks (annual review binder) for completing and enters any new liability changes into computer system.
Posts ancillary charges daily, processes mail daily, scans as needed daily, posts payments, and prepares deposits daily and takes to banks.
Maintains current resident accounts and contact information in the computer system to avoid loss of claims. Always verifies resident account number.
Maintains a computer master list of insurance companies outlining correct name and address.
Maintains and audits financial files.
Admissions to NH - Social Security Rep Payee submission, Disability application done as needed, Georgia Medicaid application - follow up weekly.
Medicaid renewals and representative payee reports received and completed.