Medicare Billing Specialist

Position Highlights:

The Medicare Billing Specialist reviews claims for completeness, reasonableness of charges and appropriateness of billing codes and Medicare information. The MBS work edits, bill holds, verifies Medicare/Insurance prior to submitting electronically, or hard copy claims if appropriate. The MBS works Medicare claims On-line DDE, (RTP) return to provider and (ADR) additional development request and assures all billing requirements are met for Research claims.

The Ideal Candidate:

·Exhibits a problem-solving attitude; constantly seeks ways to improve processes, increase efficiency, and find solutions to current situations or to develop new methods and procedures.

·Ability to multi-task and prioritize work in a deadline driven environment

·Works effectively and constructively to find mutually beneficial solutions for all concerned parties.

·Must be able to work collaboratively in a multi-team environment.

·Accepts accountability for actions, choices, and outcomes; assumes nothing; answers for own conduct and obligations.

·Is dedicated to superior customer service and satisfaction.

Responsibilities

·Work Medicare claims by clearing CCI/Internal edits and working bill holds within ePremis billing system.

·Review, electronic EOB (835) for the primary payer, make corrections to and ensures the legibility of outgoing MSP claims.

·Daily billing of Medicare/MSP Claims

·Verifies Medicare and Insurance information and checks each claim for correctness on daily basis.

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

·Shares responsibility transmitting claims.

·Make all Medicare corrections on-line DDE.

·Analyze rejection codes and volumes. Report findings to Manager, Supervisor or Lead.

·Assist with rectifying ongoing rejection reasons

·Request Medical records on requested ADR's.

·Submit insurance informational, no-pay claims and ancillary claims.

·Makes adjustments when necessary to all Medicare claims.

·Rebilling claims as needed, resubmitting unpaid claim that have rejected or have not paid.

·Respond to questions and inquiries from other departments concerning the account that have not been paid by Medicare.

Credentials and Qualifications:

·Associate's Degree

·Minimum of four (4) years' experience working in a hospital, physician, or other medical services facility.

·Minimum of three (3) years' experience in healthcare billing in Medicare Part A/B and Medicare secondary payers.

o   In lieu of Associate's degree, a H.S. Diploma with two (2) years' (for 5 years total) of additional related healthcare billing, patient financial services and/or revenue cycle experience may be considered. 

·Solid understanding of Medicare billing rules and regulations.

·Knowledge of third-party payers according to guidelines set forth in the department policy and procedure manual.