Community Representative Jobs

Job Overview

The Long-Term Care Billing Specialist is responsible for accurate and timely billing for Nursing Home, Assisted Living and waivered services. This position prepares and processes resident statements, posts payments and adjustments, reviews account balances, and assists with resolving billing discrepancies. The role works closely with residents, families, facility staff, and third-party payers to address billing questions and ensure accurate account records. Additional responsibilities include reconciling accounts, monitoring outstanding balances, billing for meals on wheels and assisting with month-end reporting. The ideal candidate is detail-oriented, organized, maintains confidentiality, and demonstrates strong communication and customer service skills while supporting the financial operations of the organization.

Standard Requirements

Supports the mission, vision, and values that make us SHINE at Appleton Area Health.

Adhere to AAH Code of Conduct

Adhere to facility policies

Supports, cooperates with, and implements specific procedures and programs for:

• Safety, including universal precautions and safe work practices, established fire/safety/disaster plans, risk management, and security, report and/or correct unsafe working conditions, equipment repair, and maintenance needs.
• Confidentiality of all data, including resident, employee, and operations data.
• Quality assurance and compliance with all regulatory requirements.
• Compliance with current law and policy to provide a work environment free from sexual harassment and all illegal and discriminatory behavior.

Supports and participates in common teamwork:

• Cooperates and works together with all co-workers; plans and completes job duties with minimal supervisory direction including appropriate judgment.
• Uses tactful, appropriate communication in sensitive and emotional situations.
• Follows up as appropriate with supervisor, co-workers, or residents regarding reported complaints, problems, and concerns.
• Promotes positive public relations with residents, family members, and guests.
• Completes requirements for in-service training, acceptable attendance, uniform dress codes including personal hygiene, and other work duties as assigned.

Required Knowledge, Skills, and Abilities

Education/Training:

• High school diploma or equivalent.
• Previous billing, accounts receivable, bookkeeping, or healthcare financial experience preferred.
• Knowledge of long-term care billing, Medicare, Medicaid, and private-pay processes preferred.
• Proficiency with computers, spreadsheets, and financial or billing software.
• Effective communication, customer service, and problem-solving skills.
• Ability to organize work, prioritize deadlines, and maintain confidentiality.

Skills:

• Analytical—the individual synthesizes complex or diverse information.
• Problem solving—the individual identifies and resolves problems in a timely manner and gathers and analyzes information skillfully
• Oral communication—the individual speaks clearly and persuasively in positive or negative situations, demonstrates group presentation skills and conducts meetings.
• Quality management—the individual looks for ways to improve and promote quality and demonstrates accuracy and thoroughness.
• Judgment—the individual displays willingness to make decisions, exhibits sound and accurate judgment and makes timely decisions.
• Planning/organizing—the individual prioritizes and plans work activities, uses time efficiently and develops realistic action plans.
• Safety and security—the individual actively promotes and personally observes safety and security procedures and uses equipment and materials properly.

ESSENTIAL FUNCTIONS:

Nursing Home Billing

• Meet with resident/family members upon admission to obtain accurate financial information.
• Process necessary insurance forms in an accurate, timely and efficient manner.
• Follow up by phone or online with third-party payers that have not made the appropriate payment within the required time frame and send follow-up correspondence as needed.
• Respond to inquiries concerning account balances, third party payments, etc., from patients, relatives and/or third-party payers in a timely manner.
• Adhere to third part payer administrative requirements (prior authorization, re-certification, etc.) as needed.
• Routinely review accounts receivable aging reports and date-of-service histories for payment activity.
• Follow up on care center past due accounts and coordinate with the social worker regarding any unpaid balance upon resident discharge.
• Prepare quarterly Medicare credit balance reports.
• Prepare and maintain accurate care center census.
• Prepare annual rate notice letters and mail to care center responsible party.
• Responsible for a variety of office/clerical tasks relating to medical billing.
• All other duties as assigned by supervisor.

Assisted Living Billing

• Meet with resident/family members upon admission to obtain accurate financial information.
• Process necessary insurance forms in an accurate, timely and efficient manner.
• Contact third party payers within payer’s time frame by telephone or online that have failed to make appropriate payments with follow-up correspondence.
• Respond to inquiries concerning account balances, third party payments, etc., from patients, relatives and/or third-party payers in a timely manner.
• Adhere to third part payer administrative requirements (prior authorization, re-certification, etc.) as needed.
• Routinely review accounts receivable aging reports and date-of-service histories for payment activity.
• Follow up on Assisted Living past due accounts.
• Prepare quarterly Medicare credit balance reports
• Prepare and maintain accurate Assisted Living/Home Health census.
• Prepare annual rate notice letters and mail to tenants of Apple Ridge.
• Responsible for a variety of office/clerical tasks relating to medical billing and other administrative office duties as assigned.
• All other duties as assigned by supervisor

Pay: $19.30 - $26.05 per hour

Expected hours: 64.0 – 80.0 per week

Benefits:

• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Work Location: In person