Medicare Specialist, 250 E. Liberty, 7:30a-4:00p

UofL Health•Louisville, KY

1d•Onsite

About The Position

This position requires thorough knowledge of the Uniform Bill, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicare eligibility, benefits, determining primary payer, and covered benefits.

Requirements

High School Diploma or GED/Equivalent (required)
One (1) year of patient registration, billing or equivalent experience (required)
Knowledge of general insurance requirements
Experience working directly with EOBs and contractual adjustments
Ability to communicate verbally/in writing with professionalism
Ability to meet productivity expectations
General computer knowledge
Must have the ability to learn and use relevant systems appropriately
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
Maintains confidentiality and protects sensitive data at all times
Adheres to organizational and department specific safety standards and guidelines
Works collaboratively and supports efforts of team members
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community

Nice To Haves

Working knowledge of medical and insurance terms (preferred)

Responsibilities

Monitors and resolves claims holding on discharged not final billed (DNFB) list
Ensures claims are filed electronically except for specified paper claims
Identifies payers being submitted on paper rather than electronically and communicate the opportunities to leadership
Follows up on unpaid Medicare and Medicare Advantage claims in a timely manner
Ensures high-dollar accounts have consistent follow up until the account has been resolved
Responsible for reviewing and understanding explanation of benefits/remittance advice
Ensures statements are generated for the patient responsibility amounts
Utilizes insurance websites to view and resolve claims
Performs extensive account follow-up and provide analysis of problem accounts
Documents all follow up efforts in a clear and concise manner into the AR system
Submits shadow claims to Medicare for inpatient Medicare Advantage payers
Audits and researches accounts, payment postings and contractuals to confirm the accuracy of the balance of the account
Adheres to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers
Ensures medical record requests are documented and submitted in a timely manner
Makes phone contact with patient, physician office, attorney, etc. for additional information to process claims, as needed
Identifies and reports all trends that may provide insight into payment challenges
Maintains familiarity with inpatient-only procedure list and works with Revenue Cycle leadership to prevent denials
Works on assigned accounts as directed while reaching daily productivity goals
Completes tasks by deadline
Attends seminars as requested
Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
Maintain compliance with all company policies, procedures and standards of conduct
Performs other duties as assigned