Physical Demands and Working Conditions:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. In compliance with ADA requirements, reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Work Environment:

Employee must be able to work effectively within an interdisciplinary team model, interfacing and collaborating with a wide range of clinical and social services disciplines who work together to manage the PACE participants’ care. The work setting is in an Adult Day Health Center and primary care clinic environment with moderate noise levels and controlled temperatures.

Physical Requirements:

Requires manual and finger dexterity and eye-hand coordination; the ability to use department equipment; and the ability to lift/carry up to 30 pounds using appropriate body mechanics with reasonable accommodation if needed.

Visual, Hearing and Communication Requirements:

Requires corrected vision and hearing to normal range, with or without reasonable accommodation. Ability to communicate by way of the telephone with participants, customers, vendors and staff.

Pressure Factor:

Requires working under stressful conditions. Working conditions may be noisy and crowded and fluctuating indoor temperatures. Moderate pressure to meet scheduled deadlines. Potential for exposure to verbal aggression by client, vendors, and staff.

Environmental Conditions:

May be exposed to a risk of bodily injury through contact with moving instrumentation, toxic substances, medicinal preparations, bodily fluids, communicable diseases and any other conditions common in a healthcare environment. Subject to unpleasant odors.

Duties and Responsibilities:

The principle duties of this position include, but are not limited to, the following; 

Medicare / Medicaid capitation proceeds

• By the 5th of each month submit a listing of participant Enrollments and Disenrollment’s with appropriate documentation to Medicare and Medicaid and a listing of it to IDT. 
• Complete a monthly Capitation Report form detailing per site proceeds to be received by all participants from Medicare A and/or B, Medicaid, or private pay.
• Annually complete a detailed income summary report, for annual audit, by reconciling the PACE organization General ledger Medicare/Medicaid/Private Pay/ income accounts to the Capitation Report forms and detail member months.
• Reconcile remittance advises from Medicare and Medicaid to Capitation Report form on a monthly basis. 
• Monthly prepare Medicaid pending list.
• If a Medicaid pending application is not approved within three months, submit a disenrollment letter to the participant/Center Director /Social Worker, State Medicaid Office, and appropriate county office.

Daily Cash Receipts

• Upon receipt of checks payable to  the PACE organization or participant needs accounts, endorse with proper PACE organization endorsement stamp, record on cash receipt form, prepare bank deposit slip and make daily deposit at bank.  Attach the bank deposit confirmation slip to the cash receipt form.
• Upon deposit, prepare journal entries for all cash receipts and monthly reconcile to bank statement.  Enter and post all entries within accounting system.

Invoicing Participants

• By the 15th of the month, prepare and send the next month invoices through Solomon for all private pay participants as well as employee COBRA payments.  Also submit invoices for miscellaneous participant items that are payable to the PACE organization.
• Review the accounting systems accounts receivable ledger by 10th of the month, for delinquent payments.  Submit 30-day disenrollment letters at month end along with statement if payment has not been received.
• At fiscal year-end review with Accountant all accounts determined uncollectible and prepare a schedule detailing those to be written off.

Month-End Financial Statement Close

• Reconcile Accounts Receivable Ledgers to General Ledger monthly and prepare reconciliation reports by end of month.
• Submit grant draw requests for Veterans Administration and other grantors.

General Accounting Duties

• Be available to provide other services as requested by Accounts Receivable and Risk Adjustment Supervisor or Controller.
• Follows all PACE organization Policies and Procedures and OSHA safety guidelines and Universal Precautions.
• Maintains the confidentiality of all company procedures, results, and information about participants, clients or families.
• Maintains courteous, helpful and professional behavior on the job. Displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issues. Ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards. Will support the success of the entire healthcare team.
• Maintains safe working environment. Follows all PACE organization Safety Policies and Procedures.
• Participates in continuing education classes and any required staff and training meetings.  Maintains professional affiliations and any required certifications.
• Performs other duties as required or requested in a positive and helpful manner to ensure a smooth running work area.