Medicare Billing rep

UAB St. Vincent's•Birmingham, AL

7h•Hybrid

About The Position

This position is for a Medicare Billing Representative within the Southview Medicine Billing Office. The role involves determining and verifying insurance coverage and coordination of benefits from all sources for the assigned area, ensuring proper, adequate, and timely billing for prompt payment. Key responsibilities include confirming insurance coverage, determining the necessity for pre-authorization, and obtaining authorizations for scheduled procedures. The representative will also determine financial responsibility for services, notify patients and practitioners of unauthorized services, and communicate financial responsibility and insurance coverage issues. Detailed documentation of all billing activities and claims processed is required, along with preparing and completing claims for various insurance companies and government payers. The role also involves researching, analyzing, and reconciling Medicare/Medicaid billing and reimbursement practices, consulting to resolve unbilled claims, and reviewing accounts for proper billing and reimbursement.

Requirements

High school diploma or GED required.

Responsibilities

Determine and verify insurance coverage and coordination of benefits from all sources for assigned area. Ensure proper adequate and timely billing to ensure prompt payment.
Confirm insurance coverage.
Determine necessity for pre-authorization and obtain authorization for scheduled procedures.
Determine financial responsibility for services to be provided.
Notify patients and/or practitioners of any services requested and/or referred that are not authorized by insurance.
Communicate with patients and practitioners regarding financial responsibility and insurance coverage issues.
Maintain detailed documentation in the patient account record of all billing activities.
Maintain documentation of claims processed as part of the daily claims reconciliation process.
Prepare and complete claims for commercial insurance companies, third party organizations and/or government or self payers.
Research, analyze and reconcile Medicare/Medicaid billing and reimbursement practices.
Consult with appropriate parties to resolve unbilled claims.
Review recent accounts for proper billing practices and reimbursement.