Role Description
The Medicare Biller is responsible for the compliant, accurate and timely billing of all hospital Medicare and Medicare Advantage (Medicare HMOs) patient accounts. The position requires a strong understanding of Medicare billing processes and the ability to manage multiple tasks effectively. This role involves identifying and correcting errors to ensure prompt payment of outstanding accounts.
• Generate and submit claims, both electronic and paper claims (UB-04 and HCFA-1500) to Medicare and Medicare Advantage (Medicare HMOs), ensuring they adhere to billing guidelines and regulations.
• Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met.
• Review unreleased claims daily in order to resolve and release to the payer.
• Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.
• Resolve claim edits based on documented processes in the electronic billing system.
• Resolve requests in all designated billing queues daily.
• Complete secondary claim releases daily.
• Submit shadow bill (IME/Information only claims) to Medicare.
• Process Medicare Return to Provider (RTP) claims and denial reports on a daily basis.
• Analyze claims data and identify discrepancies or errors and make necessary corrections in the billing system.
• Keep abreast of Medicare/Medicare MA government requirements and regulations.
• Experience and knowledge with working the Medicare Quarterly Credit balance report.
• Knowledge and understanding of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes.
• Ability to navigate and fully utilize Medicare Administrative Contractors (MACs) and CMS web sites.
• Ensure claim information is complete and accurate to maximize the clean claim rate.
• Process rejections by correcting any billing error and resubmitting claims.
• Place unbillable claims on hold and communicate necessary information to various departments.
• Process late charge claims in the event that charges are not entered in a timely fashion.
• Submit corrected and/or replacement claims as needed.
• Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing.
• Limit the number of unreleased claims by reviewing all imported claims.
• Meet billing productivity and quality requirements as developed by Leadership.
• Follow up on unprocessed claims until resolution is achieved.
• Generate letters to insurance or patients as needed to resolve unpaid claim issues.
• Work independently and make decisions relative to individual work activities.
• Keep documentation clear, concise, and to the point.
• Create appropriate documentation, correspondence, emails, etc.
• Make phone calls, use payer or third-party vendor portals, and send mail for follow-up on claims.
• Maintain work procedures pertinent to the job assignment.
• Complete cross-training as deemed necessary by management.
• Proactively identify opportunities to improve business results.
• Maintain close working relationships with facility counterparts for effective revenue cycle management.
Qualifications
• 2-5 plus years in a hospital setting with at least 1 year background in Medicare and Medicaid hospital billing and follow-up functions required.
• Experience with electronic health records and medical billing software.
• Must exhibit very strong analytical and compliance issues skills.
• Knowledge of hospital billing requirements; Medicare and Medicaid billing rules, regulations, and deadlines.
• Knowledge of revenue cycle management best practices.
• Ability to manage multiple tasks effectively and efficiently.
Requirements
• Strong understanding of Medicare billing processes.
• Ability to manage multiple tasks effectively.
• Strong customer service skills.
• Good verbal and written communication skills.
• Analytical skills to ensure compliance with Medicare regulations and guidelines.
Benefits
• Competitive pay range: $18 to $22 per hour.
• Healthcare benefits.
• 401(k) plan.
• Paid time off.
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