Overview

The Accounts Receivable Specialist Medicare I coordinates all billing and collection activitiy as related to the Medicare accounts receivable. Assists in the daily maintenance of Medicare billing guidelines and compliance. Performs other patient account duties as assigned.

Responsibilities

PART III:
POSITION RESPONSIBILITIES (ESSENTIAL FUNCTIONS)Ability to accurately review and bill all secondary and tertiary insurances to correct charges, bill forms and supporting documentation (EOBs). Appropriately identify denied claims, work to ensure that trends are identified and resolved quickly. Maintain daily billing queues by working claim edits or following up on claim issues. Maintain patient demographic information. Maintain the assigned Medicare, Medicare Part C, and Medicare Part B Only financial class receivables>120 days at 5% or less. Maintaining A/R by the use of Telephone, Internet, Worklists, Queues, ATBs and appropriate letters. File and re-file claims to insurance companies. Other duties as assigned.

Provides accurate and timely billing of all electronic and paper claims, including but not limited to:
download, edit and transmit claims. Responsible for timely and accurate review of the rejected claims to ensure that all claims were accepted by the payer. Also has the knowledge to correct any rejections to ensure claims are rebilled timely. Understands and applies Medicare LCD and NCD requirements-reviewing those cases that fail medical necessity and performing proper follow-up to ensure compliance with the regulations. Understands billing requirements for Medicare and Medicare Part C or MMAI plans billing as defined by contract, state or federal law.

Qualifications

Experience/Education Requirements:
  • High school graduate or equivalent
  • Prior Medicare billing experience preferred
  • Excellent guest relation skills, including verbal and written
  • PC and keyboarding skills @ 30 WPM
  • Ability to work independently
  • Two years hospital patient accounting experience (preferred)
  • ICD10/CPT Medical Terminology Preferred
  • Previous collections or insurance experience p>License or Certification Requirements:
  • HFMA Credentialed Revenue Cycle Representative, preferred
  • Complete 10 hours of Medicare University between July 1 and May 31 each year. Submit report from Medicare University in Halogen and copy to Manager/Director for proof of completion.
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