Billing Specialist I - FT - Days - MSS

About the role

The Billing Specialist is responsible for resolving claim edits for payors using the knowledge of the appropriate billing form and billing guidelines as well as various insurance contracts and payment methodologies to ensure a compliant claim. Reviews the claims to confirm the correct insurance filling order to ensure the correct payment at the time of initial submission. Ensures compliant billing based on the Office of Inspector General (OIG), CMS, HIPPA and any specific payor regulation.

Responsibilities

• Resolves claims edits monthly for skilled nursing/long term care for accurate and timely submission of paper and/or electronic claims.
• Documents all billing activities in patient account record to accurately reflect what changes have been made to the claim/or insurance information.
• Identifies billing errors trends and directs these trends to management for review and/or resolution.
• Confirms and corrects patient insurance information by calling the guarantor and/or mail inquires for accident insurance, workman's comp, or other needed insurance information. Updates account with any discovered insurance and notates the account with the new insurance information. Applies the unsolicited 271 transaction to add the insurance to the account, when applicable.
• Creates and submits Part B only claim to Medicare for inpatient services when Medicare Part A benefits are exhausted. If another insurance is also available for billing, reviews and submits a claim for the non-covered Part A services to that payor for payment.
• Works in appropriate claim system for Medicare and Medicaid to resolve overpayments by the payor by updating claim information in their system.
• Sets up and submits RAC reviews into the third-party software. Requests medical records and coordinates the response to the RAC request.
• Enters all Recovery Audit Contractor (RAC) reviews into the third-party software. Requests medical records and coordinates the response to the RAC request.
• Reviews coding to ensure that the procedures coded are billable according to the regulations set by the different payors. Adds applicable billing modifiers, when needed. Resolves clearinghouse errors and resubmits the claim for processing.
• Bills secondary or tertiary insurance by interpreting the explanation of benefits (EOB) from the payor. Adjusts or bills late charge/credit replacement claims using insurance payment methodologies.

Qualifications

• High School Diploma or Equivalent
• Knowledge of UB–04 and/or CMS 1500 form, billing guidelines, insurance contract and payment methodologies
• Excellent communication skills, critical thinking skills, decisive judgment and the ability to work with minimal supervision

Skills

• Excellent communication skills
• Critical thinking skills
• Decisive judgment
• The ability to work with minimal supervision

Benefits

Not specified

Pay

Not specified

Schedule

Not specified