Medical Biller - Medicare Biller & A/R Follow-Up (Hospital/Facility)

We are a privately owned revenue cycle management company providing comprehensive revenue cycle services to hospitals and other healthcare provider organizations. We are seeking a full-time, experienced Medicare A/R Representative to manage Medicare billing and follow-up for hospital claims on behalf of our hospital clients. This role is responsible for handling facility claims across Medicare Part A and Part B, including inpatient, outpatient, and observation services.

Key Responsibilities:

• Process, review, and submit Medicare claims (UB04) for hospital inpatient (Part A) and outpatient (Part B) services in compliance with CMS guidelines.
• Utilize Medicare Direct Data Entry (DDE) to check claim status, correct errors, RTP issues, and resubmit claims as needed.
• Analyze remittance advice (835/ERA/EOB) to identify underpayments, denials, and payment variances.
• Follow up on unpaid or incorrectly paid claims to ensure proper reimbursement.
• Identify denial trends and proactively address root causes in collaboration with internal teams.
• Stay current on Medicare regulations and requirements such as LCDs and NCCI edits.
• Maintain confidentiality and comply with HIPAA and organizational policies.
• Work within applicable systems to review accounts aiming for proper Medicare and other payer reimbursement.
• Ensure timely and accurate billing compliance with Medicare regulations.
• Conduct ongoing account follow-up to maximize reimbursement.
• Communicate effectively with internal teams, Medicare representatives, clients, and others.
• Collaborate with coding, registration, and clinical teams to correct billing discrepancies.
• Respond professionally and accurately to patient and payer billing inquiries.
• Assist in implementing process improvements to enhance billing efficiency and reduce errors.

Qualifications:

• Minimum of 3 years Medicare hospital billing and follow-up experience (inpatient and outpatient).
• Strong working knowledge of Fiscal Intermediary Standard System (FISS).
• 3+ years experience using Meditech.
• Strong knowledge of Medicare DDE and RTP processes.
• In-depth understanding of Medicare Part A and Part B billing requirements.
• Knowledge of CPT, ICD-10, and HCPCS coding concepts related to billing and reimbursement.
• California Medicare billing experience and additional payer knowledge are pluses.
• High attention to detail, strong organizational skills, and ability to work independently.
• Proficiency in Microsoft Office; knowledge of medical terminology.

Work Environment:

• Office-based position with potential for remote/hybrid work based on performance and needs.

Benefits:

• 401(k), dental, health, vision, life insurance
• Health savings account
• Paid time off