Medicare Pt B Billing & Accred. Spec.

Responsibilities

• Weekly pay, health and dental after your first month, student loan repayment, a competitive 401(k) match, and more!
• Makes a living while making a difference at Trilogy Health Services – a senior living provider with the continuous goal of being the Best Healthcare Company in The Midwest.

Qualifications

• Serves as a subject matter expert (SME) in Medicare Part B billing and documentation requirements.
• Manages complex pharmacy billing activities, ensuring compliance with CMS regulations, and driving resolution of systemic issues impacting reimbursement and operational effectiveness.
• Interprets and applies CMS regulations, Local and National Coverage Determinations, and payer-specific billing and documentation requirements.
• Ensures all claims are submitted accurately and in compliance with Medicare Part B, Major Medical, and Medicaid billing guidelines.
• Maintains audit-ready documentation standards and ensures all required documentation exists, is complete, and supports billed services.
• Operates with minimal supervision while contributing to cross-functional initiatives and process improvements.
• Independently prioritizes and manages workload across multiple systems and platforms.
• Resolves billing discrepancies by coordinating with pharmacy staff, prescribers, payers, and business office teams.
• Identifies, analyzes, and trends systemic billing and documentation issues; determines root causes and drives appropriate escalation.
• Represents the Medicare Part B billing function in cross-functional meetings, audits, and external discussions as needed.
• Ensures patient profiles accurately reflect payer information, coverage updates, and required exceptions.
• Monitors documentation completeness and timeliness, proactively addressing gaps prior to billing.
• Supports internal and external audits, accreditation surveys, and regulatory inspections, including follow-up on corrective action plans.
• Meets or exceeds performance metrics established by Revenue Cycle leadership, while balancing quality and compliance expectations.
• Provides detailed billing analysis and reporting (e.g., Medicare Part B billing data by location), identifying trends and opportunities for improvement.