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POST DATE 8/20/2016
END DATE 10/26/2016
Senior Level. Prepares inpatient and outpatient claims either for electronic mail or hard copy and forwards to appropriate third party payers. Analyzes and reviews claims to ensure that payer specific billing requirements are met. Follows-up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
Must have minimum of 2 years experience in any of the following: Medicare, Medicaid and/or Commercial Insurance billing, collections, payment and reimbursement verification and/or refunds. Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
General hospital A/R accounts knowledge is required. College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
B. Education and Training:
HS Diploma or equivalency required
Post HS education preferred
Must have good verbal and written communication skills in order to present and explain information to internal and external customers.
Ability to write letters.
Must have practical experience with Word, Excel, Adobe applications.
Must have ability to make independent decisions that are generally guided by established procedures.
Must have a desire to learn ethical and compliant business practices.
Must be able to handle sensitive, stressful and confidential situations and account information.
Must have excellent keyboarding and 10-key skill-set.
Must have knowledge to perform functions requiring the use of the internet.
Willingness and ability to learn new tasks.
Experience with the Medicare billing process -- what claims can be rebilled online vs doing a redetermination
Understanding of Medicare language
At least five years of experience billing, collecting and validating Medicare payment
Understanding of how and when to bill Medicare as secondary
Understanding of Medicare Dialysis billing
How to read the information in the Common Working File -- HMO coverage, Hospice dates, COB screens etc.
Hand's on experience with Medicare Remote -- DDE
Understanding of and exposure to Medicare Recovery Audit Contractor
Hand's on experience with working Medicare Status Locations (ex: RTP, Denied, Suspense)
Experience with compiling both Redeterminations and Reopening's of Medicare claims
Knowledgeable in locating and referencing CMS and/or Medicare Regulations
D. Licenses, Registrations, or Certifications: