Inpatient Medicare & Medicaid Biller - Full Time Remote

IKS Health Career•Coppell, TX

2d•$18 - $22•Remote

About The Position

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. Must have working knowledge of Medicare and the complex regulations concerning Medicare reimbursement. Strong customer service, good verbal and written communication, analytical skills to be able to ensure compliance with Medicare regulations and guidelines, maintain accurate records, and communicate effectively with various stakeholders.

Requirements

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 deadline (Understands the billing and payment follow up time limits set forth by Medicare)
Knowledge of revenue cycle management best practices.
Ability to manage multiple tasks effectively and efficiently.

Responsibilities

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 and that they capture all charges and needed element to ensure prompt payment.
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.
Ability to analyze claims data and identify discrepancies or errors and make necessary corrections in the billing system to ensure accurate claims.
Understand how to resolve Medicare/Medicare MA billing edits and/or warnings and billing edits that are identified in the Patient Accounting Billing System
Keep abreast of Medicare/Medicare MA government requirements and regulations and ensure all billing practices adhere to these standards.
Experience and knowledge with working the Medicare Quarterly Credit balance report and ensure timely and accurate submission of Medicare credit balance quarterly reports.
Knowledge and understanding of: The use of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes and professional terminology. The processing of the Inpatient Lifetime Reserved (LTR) notifications, rules and regulations ABN's and the requirements when and how to appropriately bill claims for resolution MSP (Medicare Secondary Payer) files Billing TPL (Third Party Liability) claims and conditional billing Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates CMS Publication: 100-4 (Medicare Claims Processing Manual) LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity
Ability to navigate and fully utilize Medicare Administrative Contactors (MACs) and CMS web sites
Ensures claim information is complete and accurate in order to maximize the clean claim rate resulting in claim resolution and payment for complex billing and payment issues
Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.
Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers.
Place unbillable claims on hold and properly communicate to various Hospital/Client departments the information needed to accurately bill.
Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments
Submit corrected and/or replacement claims in the event that the original claim information has changed for various reasons
Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing etc.
Limit the number of unreleased claims by reviewing all imported claims and either billing or holding the claim for further review
Meet billing productivity and quality requirements as developed by Leadership as the team member is measured on high production levels, quality of work output, in compliance with established policy and standards
Follow up on unprocessed claims until a claims resolution is achieved
Generates letters to insurance or patients as needed in order to resolve unpaid claim issues.
Analyze information contained within the billing systems to make decisions on how to proceed with the account; ability to identify and resolve billing issues.
Work independently and have the ability to make decisions relative to individual work activities
Keep documentation clear, concise, and to the point, while including enough information for a clear understanding of the work performed and actions needed
Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation
Make phone calls, use payer or third party vendors portals, and send mail to payers for follow-up on unprocessed claims, incorrectly processed claims, or claims in question
Maintain work procedures pertinent to the job assignment
Complete cross-training, as deemed necessary by management, to ensure efficient department operations
Proactively identify opportunities to improve business results and/or to alert business units of trends, anomalies or health plan rules and decisions that need attention; report potential or identified problems with systems, payers, and processes to the manager in a timely manner
Maintain close working relationships with facility counterparts for effective revenue cycle management.