About Us
The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.
Business Office Representative
Position Summary:
The Business Office Representative is responsible for managing the various Business Office Duties. Functions as the primary source of information on all federal, state, and payer-specific skilled nursing facilities accounts receivable and billing regulations.
Essential Functions and Responsibilities:
- Coordinate with Admissions the appropriate pay source for new admits, re-admits, Therapeutic Leaves, and Hospital Leaves.
- Obtains and verifies new patient’s insurance information and reporting census information as requested.
- Consults with residents, families, the DHHS case manager, and resident attorneys to identify appropriate insurance plans for billing, ensures documentation is complete, and ensures the Medicaid approval process is acquired within the time allowed.
- Audit Admissions, Social Services, and MDS clinical data requirements to ensure compliance with Medicare A, B, C, and Medicaid Accounts Receivable regulations.
- Post all cash and follow-up on missing payments or short payments including identifying uncollectable accounts and prepare documentation to submit to the collection agency.
- Verify with the MDS Coordinator timing of Level of care Determinations (LOCD). Work with MDHHS Provider Support to resolved LOCD problems.
- Review denied claims or denied prior authorizations. Acquire the appropriate documentation to appeal or challenge denial.
- Audit weekly patient’s insurance coverage and meet with Interdisciplinary Team to verify PPS requirements are being reviewed.
- Validate ancillary charges and ICD-10 codes before processing claims.
- Prepare monthly invoices for private pay residents and submit hospice reconciliation report to hospice vendors.
- Coordinate with the Unit Coordinators and Medicare Coordinator the approval for patient’s schedule appointments outside the facility and their transportation needs.
- Review and understand the facilities vendor contracts (Therapy, X-Ray, Lab, etc.) to validate the correct rates or fee schedules are billed. Resolve any discrepancies and code invoices for AP processing.
13. Performs other related duties as required and directed.
Qualifications:
Required:
- High School diploma
- Three (3) years of experience in Long Term healthcare
Preferred:
- Associate Degree
- Minimum one (1) year experience billing on UBO4
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
