Medicare Specialist, 250 E. Liberty, 7:30a-4:00p

Job Description

This position requires thorough knowledge of the Uniform Bill, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicare eligibility, benefits, determining primary payer, and covered benefits.

Essential Functions

• Maintains and resolves claims holding on discharged not final billed (DNFB) list
• Ensures claims are filed electronically except for specified paper claims
• Identifies payers being submitted on paper rather than electronically and communicates the opportunities to leadership
• Follows up on unpaid Medicare and Medicare Advantage claims in a timely manner
• Ensures high-dollar accounts have consistent follow up until the account has been resolved
• Reviews and understands explanation of benefits/remittance advice
• Ensures statements are generated for the patient responsibility amounts
• Utilizes insurance websites to view and resolve claims
• Performs extensive account follow-up and provides analysis of problem accounts
• Documents all follow up efforts in a clear and concise manner into the AR system
• SUBMIT SHADOW CLAIMS TO MEDICARE FOR INPATIENT MEDICAID ADVANTAGE PAYERS
• AUDITS AND RESEARCHES ACCOUNTS, PAYMENT POSTINGS AND CONTRACTUALS TO CONFIRM THE ACCURACY OF THE BALANCE OF THE ACCOUNT
• ENSURES MEDICAL RECORD REQUESTS ARE DOCUMENTED AND SUBMITTED IN A TIMELY MANNER
• MAKES PHONE CONTACT WITH PATIENT, PHYSICIAN OFFICE, ATTORNEY, ETC. FOR ADDITIONAL INFORMATION TO PROCESS CLAIMS, AS NEEDED

Other Functions

• IDENTIFIES AND REPORTS ALL TRENDS THAT MAY PROVIDE INSIGHT INTO PAYMENT CHALLENGES
• Maintains familiarity with inpatient-only procedure list and works with Revenue Cycle leadership to prevent denials
• WORKS ON ASSIGNED ACCOUNTS AS DIRECTED WHILE REACHING DAILY PRODUCTIVITY GOALS
• COMPLETES TASKS BY DEADLINE
• ATTENDS SEMINARS AS REQUESTED
• COMPLIES WITH HIPAA PRIVACY AND SECURITY REQUIREMENTS TO MAINTAIN CONFIDENTIALITY AT ALL TIMES
• Maintains compliance with all company policies, procedures and standards of conduct
• PERFORMS OTHER DUTIES AS ASSIGNED

Education

A High School Diploma or GED/Equivalent (required)

Experience

One (1) year of patient registration, billing or equivalent experience (required)

Additional Job Description

Working knowledge of medical and insurance terms (preferred)

Job Competency

• Knowledge, Skills, and Abilities critical to this role:
• Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies
• Knowledge of general insurance requirements
• Experience working directly with EOBs and contractual adjustments
• Ability to communicate verbally/in writing with professionalism
• Ability to meet productivity expectations

Reasoning Ability

Ability to break down problems or tasks; using prior knowledge and experience to identify causes and consequences of events

Computer Skills

• General computer knowledge
• Ability to learn and use relevant systems appropriately

Additional Responsibilities

• Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
• Maintains confidentiality and protects sensitive data at all times
• Adheres to organizational and department specific safety standards and guidelines
• Works collaboratively and supports efforts of team members
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community