Responsible for compliant, accurate, and timely billing of hospital Medicare and Medicare Advantage patient accounts.
Key responsibilities include:
- Generate and submit electronic and paper claims (UB-04 and HCFA-1500) to Medicare and Medicare Advantage payers.
- Review patient financial records and claims for payer-specific requirements prior to submission.
- Resolve claim edits, rejections, and billing queue items, and resubmit corrected claims as needed.
- Process Medicare RTP claims, denial reports, shadow bills, late charges, corrected claims, replacement claims, and complex billing scenarios.
- Maintain accurate documentation and communicate with internal departments, payers, and vendors to resolve unpaid or unprocessed claims.
- Monitor Medicare requirements, claim statuses, and payment issues to support clean claim rate and revenue cycle performance.
Requirements & Qualifications
2-5+ years of experience in a hospital setting, with at least 1 year of Medicare and Medicaid hospital billing and follow-up experience.
Required knowledge and skills:
- Medicare and Medicare Advantage billing processes, reimbursement rules, and compliance requirements.
- Hospital billing requirements, revenue cycle management best practices, and claim follow-up timelines.
- UB-04 and HCFA-1500 claim forms.
- HCPCS, CPT-4, MS-DRG, AP-DRG, modifiers, POA, and ICD-10 codes.
- Medicare Secondary Payer (MSP), TPL, conditional billing, ABNs, LCDs, NCDs, and CMS publications/guidelines.
- Electronic health records and medical billing software.
- Strong analytical, communication, customer service, and organizational skills.
- Ability to manage multiple tasks effectively and work independently.
Benefits & Perks
Competitive benefits package including:
- Healthcare
- 401(k)
- Paid time off
Benefits are subject to eligibility requirements for full-time employees.
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
2 months ago
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