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Medical Liaison- Senior Reimbursement Analyst

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Inglis enables people with disabilities – and those who care for them – to achieve their goals and live life to the fullest.
It is essential that the Medicaid Liaison/Senior Reimbursement Analyst performs all duties with the highest level of integrity, while supporting Inglis Values and Standards of Excellence, ensuring the achievement of competencies and compliance with regulatory agencies.

The Medicaid Liaison/Senior Reimbursement Analyst is responsible for participating in the management of payer verifications, approvals, and accurate admission demographic data. Submitting and Tracking of Medicaid Pending applications. This includes follow up with external contacts (Social Security for change of address and completing of Rep-payee form where applicable) resident families internal stakeholders. Upon resident admission, the role is responsible for coordinating all processes with payers, admissions, and billing until the PA162 is received (by the business office). All essential job responsibilities will be executed in accordance with Inglis Administrative policies and compliance/ethics guidelines. 


In addition, this position must have knowledge of daily census updates and accurate posting of cash receipts and ancillary posting for resident and community-based services billing. This includes Medicaid, Medicare, Commercial Insurances, Private payers, and CSS and Day Program billing. Position will also help Medicaid annual renewals. In this role the Medicaid Liaison/Senior Reimbursement Analyst will perform all of their duties in accordance with policy, ensuring timely collections, possessing a total understanding of the Inglis billing process and working diligently to maintain productive business relationships with Inglis staff, residents and residents’ families as well as government agencies, overseeing RFMS system, and implementing and maintaining processes that will contribute to the attainment of the above expectations in addition to reporting all billing problems and monthly reporting to the Director of Billing and Reimbursement.

ESSENTIAL FUNCTIONS, QUALIFICATIONS & SKILLS:

Customer Focus
Is dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect. 

Approachability
Is easy to approach and talk to; spends the extra effort to put others at ease; can be warm, pleasant, and gracious; is sensitive to and patient with the interpersonal anxieties of others; builds rapport well; is a good listener; is an early knower, getting informal and incomplete information in time to do something about it.

Peer Relationships
Can quickly find common ground and solve problems for the good of all; can represent his/her own interests and yet be fair to other groups; can solve problems with peers with a minimum of noise; is seen as a collaborator and is cooperative; easily gains trust and support of peers; encourages collaboration; can be candid with peers.

Problem Solving
Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and does not stop at the first answers.

Compassion
Genuinely cares about people; is concerned about their work and non-work problems; is valuable and ready to help; is.
sympathetic to the plight of others not as fortunate; demonstrates real empathy with the joys and pains of others.


Composure
Is cool under pressure; does not become defensive or irritated when times are tough; is considered mature; can be counted on to hold things together during tough times; can manage stress; is not knocked off balance by the unexpected; does not show frustration when resisted or blocked; is a settling influence in a crisis.

Timely Decision Making
Makes decisions in a timely manner, sometimes with incomplete information and under tight deadlines and pressure: able to make a quick decision.

Delegation
Clearly and comfortably delegates both routine and important tasks and decisions; broadly shares both responsibility and accountability; tends to trust people to perform; lets direct reports finish their own work.

Directing Others
Is good at establishing clear directions: sets stretching objectives distributes the workload appropriately; lays out work in a well-planned and organized manner; maintains two-way dialogue with others on work and results; brings out the best in people; is a clear communicator.

Integrity and Trust
Is widely trusted, seen as a direct, truthful individual who can present the unvarnished truth in an appropriate and helpful manner. Should keep confidences, admits mistakes, and not misrepresent him/herself for personal gain.

Motivating Others            
Creates a climate in which people want to be their best: can motivate many kinds of direct reports and team or project members; can assess each person’s hot button and use it to get the best out of him/her; pushes tasks and decisions down; empowers others; invites input from each person and shares ownership and visibility; makes each individual feel his/her work is important; is someone people like working for and with.

Management/Leadership
Demonstrates visible and recognized expertise in AR/billing systems, including resident accounting. 
Demonstrates visible and recognized expertise in resident affairs and Medicare and Medicaid terminology. Keeps up to date with current Medicare and Medicaid regulations.
Assist in the preparation of policies and procedures for Accounting Services areas and a complete review of processes with recommendations for efficiency. 

Participates and improves day to day operations concerning AR and Billing functions.
Oversees/coordinates all billing for all payers. 
Maintains policies and procedures regarding Accounting Services AR operations.
Serves as a liaison to families on financial/billing issues.
Ensures residents’ balances are below the Medicaid limit and that funds are spent down within the rules of Department of Public Welfare.
Communicates with key departments to obtain accurate census and billing information.
Communicates adequate training and instructions to staff on billing and follow-up processes.
Interviews Residents and Families prior to admission to discuss financial issues.
Works with Medical assistance to obtain and ensure continuity of grants.
Understands the billing of ancillary charges.
Generates and analyzes Accounts Receivable reports from SOS with detailed explanations of unpaid balances.
Prepares Medicare-required reports, including quarterly credit balance reports.
Maintains the HMO accounts receivable and billing, insuring timely follow-up and communication with personnel at the HMOs.

Participates as a member of the Accounting Lead Team
Assists in developing, prioritizing, and implementing goals and targets of Accounting Services.
Assists in communicating work expectations with accounting services staff.
Assists in preparation for department meetings.


Completes performance feedback process for the Two Resident Services Coordinators and assists Controller with 
feedback process for remaining Accounting Services staff.  Provides visible and recognized expertise to all Accounting Services staff. 

PERSON CENTERED CARE

•    Champion for culture change and supportive leadership.
•    Demonstrates a real sense of inquiry and a personal willingness to learn.
•    Demonstrates the ability to take responsible actions within the parameters of the role without a constant need to be directed by others.
•    Demonstrates politeness and respectfulness and evidences the self-awareness of the effect of her/his behavior on others.
•    Demonstrates mutual respect for diversity.

PEOPLE & TEAM LEADERSHIP

•    Demonstrates Inglis people and leadership values and behaviors.
•    Demonstrates the ability to follow-up on schedules, set priorities and achieve deadlines.
•    Demonstrates the Inglis Code of Conduct and builds trusted partnerships throughout the Inglis organization.
•    Establishes and maintains effective relationships by gaining trust and respect.
•    Is approachable and easy to talk with; puts forth an extra effort to make people at ease; is patience and builds rapport with customers and is a good listener.
•    A team player and has the trust and support of peers.
•    Promotes collaboration within the department.

TECHNOLOGY:     
•    Actively engages in the use of computer systems and technology to enhance the day-to-day flow of information.
•    Encourages and supports staff on the appropriate use of computer systems and technology.
•    Understands common computer terminology and fundamentals of computers.
•    Network account login, Basic Windows skills
•    Parts of the Windows desktop
•    Use the mouse; move and resize windows.
•    File management, Open, view and print files
•    Save files, dating, and basic version control.
•    When and why to store files in Desktop (C:\ drive), OneDrive, and Shared folders.
•    Identifying, selecting, and applying a variety of learning technologies, and matching the appropriate technology to the specific learning opportunity or challenge at hand.


ROLE SPECIFIC COMPETENCIES

Regulatory   
Demonstrates an understanding of regulations governing the long-term care industry, including Department of Health, HCFA 
& JCAHO. 
Communicates with banking institutions and governmental agencies. 
Assures compliance with Inglis House policies and procedures. 

Technology
Demonstrates a detailed knowledge of automated AR and billing systems and resident fund management.
Demonstrates use of the latest technological resources and effectively applies this technology. 
Demonstrates ability in spreadsheets and other computer software programs.
    


Team Facilitation
Provides resources to staff in completion of assigned tasks.
Serves as a role model and mentor to motivate and provide guidance staff. 
Functions as a coach to improve knowledge and ability. 
Develops processes to create efficiency and educate staff. 
Participate in the training and constant improvement of staff.

Measurement of Outcomes 
Ability to identify issues and opportunities for improvement of processes and overall resident satisfaction. 
 Demonstrates the ability to identify quality indicators, analyze data and measure effectiveness to improve outcomes. 
Promotes feedback on performance and communication with staff on a daily basis.

EDUCATION & EXPERIENCE

In addition to the necessary skills and experience to perform the responsibilities outlined above, there are a number of traits that a successful candidate will possess.  

•    Bachelor’s Degree preferred.
•    The incumbent must have a minimum of ten years of relevant experience in a healthcare/business office AR/billing environment. 
•    Must have experience working with Medicaid reimbursement. 
•    Knowledge of Medicare and Medicaid regulations. 
•    Knowledge of long-term care. 
•    Must have experience with computerized billing functions, not for profit requirements and regulations, and resident fund management.  
•    Must demonstrate ability to exercise good judgement in varying situations.  
•    Must be able to use a broad knowledge of concepts, practices, and procedures to manage complex tasks and/or give guidance to others. 
•    Must use a problem-solving process in making business and personnel decisions. 
•    Must exhibit excellent verbal and written communication skills required.