Medicare Billing Representative

UAB St. Vincent's•Birmingham, AL

1d•Remote

About The Position

The Medicare Billing Representative position is within the Southview Medicine Billing Office, with a schedule of Monday through Friday, 7:30 AM - 4:30 PM. The role is remote eligible after training. This position involves determining and verifying insurance coverage, coordinating benefits, ensuring proper and timely billing, and confirming insurance coverage. Responsibilities also include determining the necessity for pre-authorization and obtaining it for scheduled procedures, as well as determining financial responsibility for services. The representative will communicate with patients and practitioners regarding financial responsibility and insurance coverage issues, maintain detailed documentation of billing activities and claims processed, and prepare claims for various insurance types. The role also involves researching, analyzing, and reconciling Medicare/Medicaid billing and reimbursement practices, consulting with parties 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.