Hospital Billing Specialist, Medicare

USPI•Dallas, GA

49d•$16 - $22

About The Position

The Hospital Billing Specialist, Medicare, works in the Centralized Training Office and focuses on billing for Medicare in an Acute Care Surgical Hospital setting. Reporting to the Billing Manager, this role is responsible for timely and accurate claim submission to help ensure maximum reimbursement. The specialist extracts and reviews information from medical and billing records, completes charge entry, transmits claims, resolves billing issues and claim rejections, and follows up on denied or unpaid claims.

Requirements

Extensive knowledge of billing processes.

Responsibilities

Pull preoperative notes from the designated transcription company.
Extract information from medical records, operative notes, invoices, progress notes, and discharge paperwork to ensure complete and accurate charge entry.
Capture implants, high-cost supplies, high-cost drugs, postoperative pain blocks, and observation times before charge submission.
Review invoice details for accuracy, including customer billing instructions, pricing, discounts, and state sales tax.
Execute the recurring billing workflow and generate and transmit claims daily.
Follow up on and resolve internal and external billing inquiries in a timely manner, including issues involving operative notes, POPM forms, invoices, and implant pricing.
Reconcile revenue and billing during the period-end close process.
Complete accurate charge entry for assigned cases and upload claims to the designated electronic claims clearinghouse daily.
Resolve claim rejections daily to ensure clean claims are transmitted to and received by the appropriate payer.
Investigate, appeal, and resolve denied or unpaid claims, ensuring correct resubmission and payment.
Navigate the DDE and make appropriate claim corrections when needed.
Manage claim resubmission queues in a timely manner.
Maintain current knowledge of health care billing laws, rules, regulations, and developments.
Complete special projects when appropriate.
Complete other duties as assigned.