Medicare Billing Specialist

Under the direction of the Director of Patient Financial Services the Medicare Billing Specialist verifies charges and Medicare/insurance information, releases Medicare and MSP claims electronically, sends hard copy claims if appropriate, follows up on all unpaid claims. Works Medicare On-Line system, past due reports, rejection reports, Medicare information requests.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

  • Effectively present information and respond to questions from groups of managers, staff members, patients, and patient families, outside agencies and the general public

  • Daily billing of Medicare/MSP claims

  • Verifies all Medicare and Insurance information and checks each bill for correctness of charges on a daily basis.           

  • Make necessary changes by working with departments throughout the hospital and the Medicare on-line-system.

  • Bills electronically all claims that are eligible

  • Bills Hard copy all claims that are not eligible for electronically remittance.

  • Shares responsibility-downloading claims into the Electronic Billing System from the main computer in addition to transmission of claims

  • Responsible for follow-up of all the above claims     

  • By using daily report follows up on the entire above Medicare, MSP, Secondary insurance claims within a 45-day period.

  • Makes all necessary Medicare corrections on the Medicare-On Line System

  • Requests Medical records on all requests from HCFA , and makes sure they are sent in a timely manner.

  • Sends in appeals when appropriate for hospital or patients

  • Makes adjustments when necessary to all Medicare claims

  • Weekly works Medicare report for timely payment of claims 

  • Consistently works the Medicaid Reject remittance for the corrections of these claims and possible resubmission.

  • Reviews, research, and resolve all Medicare Credit Balance

  • Responsible for the Quarterly Medicare Credit Balance Report; Pulls all Credit balances from a report, and reports to the Patient Accounts Director for submission of information to HCFA

  • Other duties may be assigned


 

QUALIFICATION REQUIREMENTS:

EDUCATION, EXPERIENCE, and TRAINING

   High School Diploma or equivalent required

   5 years prior health care accounts experience (Preferred)

  • Meditech knowledge Preferred

  • Receivable experience, preferably in a hospital, long-term acute care, skilled nursing facility, assisted living, and centralized billing setting.

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

     

PHYSICAL DEMANDS:

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT:

  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.