Medicare Biller

Edgehill, premier CCRC in Stamford, CT, is seeking a full time SNF Medicare Biller for our Boutique Skilled Nursing neighborhood, with an average census of 40 residents, luxury amenities, high RN, LPN and CNA staffing ratio (best in class) and full administrative support staff.

The Medicare Biller is responsible for the capture, billing, adjustment, and collection of all charges generated by the Edgehill Skilled Nursing Facility, and outpatient medical charges.

Responsibilities and Competencies

• Proficiency with Microsoft Windows software, including Excel, Word, and Outlook.
• Proficiency with claims management software systems.
• Distribution of Self-Pay invoices to residents to insure timely collections.
• 2 Years of current Medicare, Managed Care and Long-Term Care (LTC) experience required
• Experience with Medicare, and Medicare & Commercial HMO / PPO billing guidelines and rules, insurance reimbursement methods, and the claims appeal process.
• Knowledge of and ability to follow insurance carrier guidelines in order to ensure that Electronic Data Interface and paper claims are submitted with proper documentation, consent form, referral and / or authorization as needed.
• Ability to review & interpret insurance Explanation of Benefits & Electronic Remittance Advices to determine & identify reasons for claim denial, and when appropriate, appeal course of action for resolution.
• Able to identify potential problem trends such as incorrect coding or down coding, and carrier non-payment trends.
• Ability to communicate effectively both written and verbal.

QUALIFICATIONS