Medicare Specialist I

Southeast Alabama Medical Center-posted 3 months ago

Full-time

Dothan, AL

251-500 employees

Hospitals

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The position involves performing daily activities related to the reimbursement process, including claims filing and follow-up, entry of payments and adjustments, and addressing non-payment issues or payments below the contracted fee schedule. The role requires identifying repetitive errors and taking corrective actions while ensuring timely processing to maintain Accounts Receivables (A/R) totals. The employee will utilize internal and external computer systems and payer portals to resolve Medicare and Medicare Advantage/Replacement claims.

Work as part of a multi-disciplinary team to provide answers to inquiries and questions.
Troubleshoot problems and provide information.
Handle intervention or referrals with a professional and respectful customer service focus telephonically and/or in person.
Provide a variety of support services in connection to the day-to-day operations in a health care environment.
Maintain working knowledge of regulatory guidelines for billing.
Verify and load insurance coverages correctly for accurate billing.
Provide claim submission for services provided at SEH.
Work and resolve claim edits and errors daily.
Follow up on claims which did not process correctly.
Follow up with insurance companies or individuals to obtain accurate reimbursement.
Understand the use of and navigation of Medicare's DDE system and other governmental and commercial payer websites for claim status and corrections.
Accurately determine Part A and Part B Medicare coverages and billing requirements.
Review correspondence daily for appropriate follow up.
Read and understand explanation of benefit files.
Work closely with clinical team for accurate charges and modifiers.
Verify third party payer coverage.
Coordinate authorizations when appropriate.
Work closely with coding team for accurate submission on claim.
Process and follow up on payer denials, consulting with various entities for completion.
Understand hospice billing requirements and regulations.
Research and resolve client billing problems or issues.
Provide communication on the methods and principles used for billing to the customers and resolve concerns.
Study contractual terms and conditions of payment to ensure payments are made consistent with terms.
Conduct work functions to assist with late charge processes.
Work closely with third party collection vendors for accurate payment records.
Assist patients and their families with applying for financial assistance.
Establish payroll deduction transactions.
Make daily deposits to the bank.
Ensure change fill requests are complete for department's daily function.
Work with patients to develop self-pay arrangements and payment plans when applicable.
Post payments for both insurance and individuals.
Review accounts and initiate refunds when applicable.
Communicate self-pay balances for upcoming services and collect balances due.
Work with accounting department for accurate financial documentation.
Edit account for correct coverage documentation.
Apply contractual adjustments in accordance with contracts.
Print, scan and index correspondence to the appropriate account.
Work closely with electronic payment process vendor for accurate posting and adjustments electronically.
Oversee the electronic flow of the account through the billing process to include bad debt.
Perform all other duties as assigned.

High school diploma or equivalent.
Working knowledge of computers.
Previous work in a business office, registration or clinical setting.

American Academy of Professional Coders (AAPC) Coding Certification (CPC).
One (1) year of revenue cycle experience.
Working knowledge of CPT and ICD 10 coding systems.

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