Revenue Cycle Specialist - Medicare

Summary

Primarily responsible for generating billing cycles, posting payments, and following up on claims to ensure timely payment.

Essential Duties And Responsibilities

• Generates patient claims through EMR billing system.
• Uploads EMC file to clearinghouse as soon after target bill date and errors/holds are clear.
• Continue review of unsubmitted claims to avoid timely filing errors.
• Manage and hold claims waiting compliance review completion.
• Work with Revenue Cycle team to ensure billing compliance.
• Review, key or follow up on 81A (NOE) prior to submission of initial claim.
• Review, key or follow up on 815’s, 817’s and 818’s when necessary.
• Review and corrects RTP’s in the DDE system on a regular basis.
• Post Medicare PIP remittance advices through Clearinghouse auto post or manually when necessary.
• Follows up regularly on unpaid claims by using DDE or phone call to PBGA service center for assistance or unresolved claim issues.
• Document response and any follow-up actions taken in EMR.
• Work with the Dept. Director on Medicare credit balances to ensure compliance.
• Work with other Hospice agencies to ensure smooth transitions between benefit periods and sequential billing.
• Notifies the Dept. Director of any problems with claims or processes.
• Affords assistance to other Revenue Cycle Specialists as needed to meet department goals.
• Submit write off requests with documentation after all collection efforts have been exhausted to the Dept. Director.
• Runs admission report, assigns and enters appropriate ICD-10 codes into EMR based on physician CTI.
• Uses pre-bill CPT audit sample to complete compliance review through physician coding compliance software.
• Report findings to appropriate Directors and CMO.
• Report individual findings to the physician for review and resolution of the coding discrepancy.
• After physician review/approval make coding changes and note in EMR.
• Note when claim can be released to billing staff.

Requirements

• High School diploma required.
• One year college or technical school: one to three years related experience or equivalent combination of education and experience.