The Vendor is required to provide revenue cycle management and billing services – offsite at vendor location.
- Act as a bridge between agency and all third-party payers (i.e., CMS, Medicaid, and other insurance providers).
- Proficiency in long-term care medical billing and collections procedures, which includes the following:
• Claims submission: submitting claims to insurance companies accurately and promptly.
• Insurance verification: verifying patients’ insurance coverage and eligibility.
• Billing inquiries: handling inquiries from insurance companies and patients regarding billing matters.
• Denial management: resolving claim denials and resubmitting claims when necessary.
• Payment posting: oversight of posting payments received from insurance companies and patients.
• Patient billing: generating patient statements (NAMI/private pay) and managing patient billing inquiries.
• Reporting: providing regular reports on billing activity, claim status, reimbursement trends and monthly cash assessment reporting.
• Medicaid applications: managing the medicaid application process, which will include working with the agency fiscal manager and third-party vendors, if necessary, to ensure medicaid applications and reauthorizations are completed accurately and timely.
• Admissions process: working with the agency admission coordinator to ensure all insurance authorizations are obtained from prospective residents prior to admission to the facility. •ability to integrate with the agency existing EMR software, which presently includes point click care (PCC) software.
• Ability to provide troubleshooting mechanisms for multiple interdisciplinary departments while engaging in its day-to-day operations within the facility.
• Provide on-site collaboration with agency staff as needed to provide updated practices, improve regulation awareness, and otherwise help with establishing best practices/procedures within the facility. • This includes working with agency minimum data set (MDS) coordinators to ensure resident care is coded properly to maximize reimbursement.
• Proficiency in the department for medicare and medicaid (CMS) regulatory requirements related to medicare, medicaid, and third-party health insurance billing.
• Proficiency in accounts receivable and cash flow management by maintaining agency days in resident accounts receivable at sixty-five (65) days or lower.
• Medical billing services are to be provided on a mutually agreeable and available schedule, sufficient to be responsive to the requirements of the agency staff. 
• Employees are not to be accompanied on the premises by acquaintances, family members, or any other person unless said person in an authorized contractor employee.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: June 18, 2025