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Claim Adjuster

1 month ago

North Aurora, United States Asbury Gardens Careers Full time

*Claim Adjuster - FT*

Asbury Gardens • North Aurora, IL • via Asbury Campus Jobs

*Benefits*

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

• Medical, dental and vision insurance
• Paid Time Off (PTO) & six paid holidays
• Various voluntary benefits:
• Life, AD&D

Asbury Gardens is seeking a Claim Adjuster. This position will provide billing services to one or more campuses of Asbury Campus. 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.

*Job highlights*

*Qualifications*



* Bachelor of Arts or Science degree in Accounting, Healthcare or related field and 5 years of long-term care billing experience, required

* Claims Adjuster License

* 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


*Claim Adjuster Job Summary:*



* This position will provide billing services to one or more campuses of Asbury Campus

* 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.


* ** **Responsibilities:*



* 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 Free-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 monitor 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.


Asbury Court and Asbury Gardens 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.