Inpatient Medicare & Medicaid Biller - Full Time Remote

About the role

The Medicare Biller is responsible for the compliant, accurate and timely billing of all hospital Medicare and Medicare Advantage (Medicare HMOs) patient accounts. The position requires a strong understanding of Medicare billing processes and the ability to manage multiple tasks effectively. This role involves identifying and correcting errors to ensure prompt payment of outstanding accounts. Must have working knowledge of Medicare and the complex regulations concerning Medicare reimbursement.

Responsibilities

• Generate and submit claims, both electronic and paper claims (UB-04 and HCFA-1500) to Medicare and Medicare Advantage (Medicare HMOs), ensuring they adhere to billing guidelines and regulations and that they capture all charges and needed elements to ensure prompt payment.
• Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met.
• Review unreleased claims daily in order to resolve and release to the payer.
• Complete secondary claim releases daily.
• Process Medicare Return to Provider (RTP) claims and denial reports on a daily basis.
• Ability to analyze claims data and identify discrepancies or errors and make necessary corrections in the billing system to ensure accurate claims.
• Understand how to resolve Medicare/Medicare MA billing edits and/or warnings and billing edits that are identified in the Patient Accounting Billing System.
• Ensure timely and accurate submission of Medicare credit balance quarterly reports.
• Knowledge and understanding of: The use of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes and professional terminology.
• The processing of the Inpatient Lifetime Reserved (LTR) notifications, rules and regulations ABN's and the requirements when and how to appropriately bill claims for resolution.
• MSP (Medicare Secondary Payer) files Billing TPL (Third Party Liability) claims and conditional billing Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates CMS Publication: 100-4 (Medicare Claims Processing Manual) LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity.
• Ensures claim information is complete and accurate in order to maximize the clean claim rate resulting in claim resolution and payment for complex billing and payment issues.
• Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.
• Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers.
• Place unbillable claims on hold and properly communicate to various Hospital/Client departments the information needed to accurately bill.
• Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments.
• Submit corrected and/or replacement claims in the event that the original claim information has changed for various reasons.
• The billing of complex scenarios such as interim, self-audit, combined, and split billing etc.
• Meet billing productivity and quality requirements as developed by Leadership as the team member is measured on high production levels, quality of work output, in compliance with established policy and standards.
• Follow up on unprocessed claims until a claims resolution is achieved.
• Generate letters to insurance or patients as needed in order to resolve unpaid claim issues.
• Analyze information contained within the billing systems to make decisions on how to proceed with the account; ability to identify and resolve billing issues.
• Work independently and have the ability to make decisions relative to individual work activities.
• Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation.
• Maintain close working relationships with facility counterparts for effective revenue cycle management.

Qualifications

• Experience: 2-5 plus years in a hospital setting with at least 1 year background in Medicare and Medicaid hospital billing and follow-up functions required.
• Experience with electronic health records and medical billing software.
• Must exhibit very strong analytical and compliance issues skills.
• Knowledge of hospital billing requirements; Medicare and Medicaid billing rules, regulations, and deadline (Understands the billing and payment follow up time limits set forth by Medicare).
• Knowledge of revenue cycle management best practices.
• Ability to manage multiple tasks effectively and efficiently.

Skills

• Strong customer service, good verbal and written communication, analytical skills to be able to ensure compliance with Medicare regulations and guidelines, maintain accurate records, and communicate effectively with various stakeholders.
• Working knowledge of Medicare and the complex regulations concerning Medicare reimbursement.
• Understanding of: The use of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes and professional terminology.
• The processing of the Inpatient Lifetime Reserved (LTR) notifications, rules and regulations ABN's and the requirements when and how to appropriately bill claims for resolution.
• MSP (Medicare Secondary Payer) files Billing TPL (Third Party Liability) claims and conditional billing Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates CMS Publication: 100-4 (Medicare Claims Processing Manual) LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity.
• Ability to analyze claims data and identify discrepancies or errors and make necessary corrections in the billing system to ensure accurate claims.
• Understand how to resolve Medicare/Medicare MA billing edits and/or warnings and billing edits that are identified in the Patient Accounting Billing System.
• Knowledge and understanding of: The use of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes and professional terminology.
• The processing of the Inpatient Lifetime Reserved (LTR) notifications, rules and regulations ABN's and the requirements when and how to appropriately bill claims for resolution.
• MSP (Medicare Secondary Payer) files Billing TPL (Third Party Liability) claims and conditional billing Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates CMS Publication: 100-4 (Medicare Claims Processing Manual) LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity.
• Ensures claim information is complete and accurate in order to maximize the clean claim rate resulting in claim resolution and payment for complex billing and payment issues.
• Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.
• Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers.
• Place unbillable claims on hold and properly communicate to various Hospital/Client departments the information needed to accurately bill.
• Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments.
• Submit corrected and/or replacement claims in the event that the original claim information has changed for various reasons.
• The billing of complex scenarios such as interim, self-audit, combined, and split billing etc.
• Meet billing productivity and quality requirements as developed by Leadership as the team member is measured on high production levels, quality of work output, in compliance with established policy and standards.
• Follow up on unprocessed claims until a claims resolution is achieved.
• Generate letters to insurance or patients as needed in order to resolve unpaid claim issues.
• Analyze information contained within the billing systems to make decisions on how to proceed with the account; ability to identify and resolve billing issues.
• Work independently and have the ability to make decisions relative to individual work activities.
• Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation.
• Maintain close working relationships with facility counterparts for effective revenue cycle management.

Pay

The pay range for this position is $18 to $22 per hour. Pay is based on several factors, including but not limited to current market conditions, location, education, work experience, certifications, etc.

Benefits

• IKS Health offers a competitive benefits package including healthcare, 401(k), and paid time off (all benefits are subject to eligibility requirements for full-time employees).

About IKS Health

www.ikshealth.com