Medicaid/Medicare Billing Specialist

Responsible for the timely and accurate resolution of insurance claims, primarily for Medicare, Medicaid, and HMO plans. This role involves follow-up on claims from billing through final resolution, identifying and correcting errors, and ensuring prompt payment of outstanding accounts.

Key responsibilities

• Monitor the progress of insurance claims from submission to payment.
• Work with Medicare, Medicare HMO, Medicaid, and Medicaid HMO payers.
• Identify and resolve claim denials, rejections, and delays.
• Follow up with insurance carriers to expedite claim payments.
• Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.
• Make necessary corrections in the billing system to ensure accurate claims.
• Process Medicare RTP claims and denial reports on a daily basis.
• Ensure timely and accurate submission of Medicare credit balance quarterly reports.
• Research outstanding accounts and take appropriate action to secure prompt payment.
• Analyze system-generated reports to identify accounts requiring research.
• Document all resolution activities in the appropriate system and log.
• Alert supervisors or managers of non-payment trends.
• Research partial payments to determine whether the appropriate contractual allowance was calculated.
• Initiate corrective action for miscalculated allowances, including collaboration with clinical departments.
• Research rejected or denied services and determine corrective action.
• Complete corrective action using departmental procedures and policies.
• Complete productivity reports and submit them within the established timeframe.
• Support customer service and performance improvement goals.
• Collaborate with other staff to enhance patient care and service.
• Maintain strict confidentiality of patient information.