Medicare Specialist, 250 E Liberty

UofL Health•Louisville, KY

16d•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. Monitor and resolve claims holding on discharged not final billed (DNFB) list. Assure all claims are filed electronically except for some paper claims. Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership. Follow up on unpaid Medicare and Medicare Advantage claims in a timely manner. High dollar accounts will have consistent follow up until the account has been resolved. Responsible for reviewing and understanding explanation of benefits/remittance advice. Assure statements are generated for the patient responsibility amounts. Utilize insurance websites to view and resolve claims. Perform extensive account follow-up and provide analysis of problem accounts. Document all follow up efforts in a clear and concise manner into the AR system. Submit shadow claims to Medicare for inpatient Medicare Advantage payers. Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account Adhere to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers. Assure medical record requests are documented and submitted in a timely manner Submit RAC correspondence to appropriate Denials/Appeals Specialist. Identify and report all trends that may provide insight into payment challenges. Phone contact with patient, physician office, attorney, etc for additional information to process claims. Work assigned accounts as directed while reaching daily productivity goals. Complete tasks by deadline. Attend seminars as requested. Other duties as assigned.

Requirements

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
thorough understanding of Medicare eligibility, benefits, determining primary payer, and covered benefits

Responsibilities

Monitor and resolve claims holding on discharged not final billed (DNFB) list.
Assure all claims are filed electronically except for some paper claims.
Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.
Follow up on unpaid Medicare and Medicare Advantage claims in a timely manner.
High dollar accounts will have consistent follow up until the account has been resolved.
Responsible for reviewing and understanding explanation of benefits/remittance advice.
Assure statements are generated for the patient responsibility amounts.
Utilize insurance websites to view and resolve claims.
Perform extensive account follow-up and provide analysis of problem accounts.
Document all follow up efforts in a clear and concise manner into the AR system.
Submit shadow claims to Medicare for inpatient Medicare Advantage payers.
Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials
Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account
Adhere to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers.
Assure medical record requests are documented and submitted in a timely manner
Submit RAC correspondence to appropriate Denials/Appeals Specialist.
Identify and report all trends that may provide insight into payment challenges.
Phone contact with patient, physician office, attorney, etc for additional information to process claims.
Work assigned accounts as directed while reaching daily productivity goals.
Complete tasks by deadline.
Attend seminars as requested.
Other duties as assigned.