[Hiring] Inpatient Medicare & Medicaid Biller @IKS Health Career

Role Description 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.

• 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.
• 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.
• Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.
• Resolve claim edits based on documented processes in the electronic billing system.
• Resolve requests in all designated billing queues daily.
• Complete secondary claim releases daily.
• Submit shadow bill (IME/Information only claims) to Medicare.
• Process Medicare Return to Provider (RTP) claims and denial reports on a daily basis.
• Analyze claims data and identify discrepancies or errors and make necessary corrections in the billing system.
• Keep abreast of Medicare/Medicare MA government requirements and regulations.
• Experience and knowledge with working the Medicare Quarterly Credit balance report.
• Knowledge and understanding of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes.
• Ability to navigate and fully utilize Medicare Administrative Contractors (MACs) and CMS web sites.
• Ensure claim information is complete and accurate to maximize the clean claim rate.
• Process rejections by correcting any billing error and resubmitting claims.
• Place unbillable claims on hold and communicate necessary information to various departments.
• Process late charge claims in the event that charges are not entered in a timely fashion.
• Submit corrected and/or replacement claims as needed.
• Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing.
• Limit the number of unreleased claims by reviewing all imported claims.
• Meet billing productivity and quality requirements as developed by Leadership.
• Follow up on unprocessed claims until resolution is achieved.
• Generate letters to insurance or patients as needed to resolve unpaid claim issues.
• Work independently and make decisions relative to individual work activities.
• Keep documentation clear, concise, and to the point.
• Create appropriate documentation, correspondence, emails, etc.
• Make phone calls, use payer or third-party vendor portals, and send mail for follow-up on claims.
• Maintain work procedures pertinent to the job assignment.
• Complete cross-training as deemed necessary by management.
• Proactively identify opportunities to improve business results.
• Maintain close working relationships with facility counterparts for effective revenue cycle management.

Qualifications

• 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 deadlines.
• Knowledge of revenue cycle management best practices.
• Ability to manage multiple tasks effectively and efficiently.

Requirements

• Strong understanding of Medicare billing processes.
• Ability to manage multiple tasks effectively.
• Strong customer service skills.
• Good verbal and written communication skills.
• Analytical skills to ensure compliance with Medicare regulations and guidelines.

Benefits

• Competitive pay range: $18 to $22 per hour.
• Healthcare benefits.
• 401(k) plan.
• Paid time off.

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