Medicare Billing and Follow-up Representative

The Medicare Billing and Follow-up Representative are responsible for the compliant, accurate and timely billing and follow-up of all hospital Medicare and Medicare Advantage Patient Accounts.

Duties and responsibilities described represent the general tasks performed on a daily basis, but not limited as other tasks may be assigned.

• Submit Medicare/Medicare Advantage plan claims both electronic and paper claims (UB-04 and 1500) to the appropriate government and non-government payers.
• Submit shadow bill (Information only claims) to Medicare.
• Understand how to resolve Medicare/Medicare MA billing edits and/or warnings and billing edits that are identified in the Patient Accounting Billing System.
• Knowledge of working F.I.S.S. (Florida Institutional Shared System) in order to resolve Medicare claim issues.
• Keep abreast of Medicare/Medicare MA government requirements and regulations.
• Understand ABN’s and the requirements when and how to appropriately bill claims for resolution.
• Experience and knowledge with working the Medicare Quarterly Credit balance report.
• Experience in ICD-10, CPT-4 and HCPC professional terminology.
• Knowledge and understanding regarding the processing of the In-Patient lifetime reserved notifications, rules and regulations.
• Knowledge and understanding working MSP (Medicare Secondary Payer) files.
• Knowledge and understanding billing TPL (Third Party Liability) claims and conditional billing.
• Current knowledge of Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates.
• Understands LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity.
• Ability to navigate and fully utilize Medicare Fiscal Intermediary (Palmetto GBA) and CMS web sites.
• Understanding of the CMS Publication: 100-4 (Medicare Claims Processing Manual).
• Ensures claim information is complete and accurate in order to maximize the clean claim rate resulting in claim resolution and payment for complex billing and payment issues.
• Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an.
• Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers.
• Place unbillable claims on hold and properly communicate to various Hospital departments the information needed to accurately.
• Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments.
• Submit corrected claims in the event that the original claim information has changed for various reasons.
• Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing etc.
• Limit the number of unreleased claims by reviewing all imported claims and either billing or holding the claim for further review.
• Meet Billing and Follow-up productivity and quality requirements as developed by Leadership.
• Measured on high production levels, quality of work output, in compliance with established CRH's policy and standards.
• Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met.
• Keep abreast of payer-specific and government requirements and regulations.
• Follow up on unprocessed or unpaid claims until a claims resolution is achieved.
• Generates letters to insurance or patients as needed in order to resolve unpaid claim.
• Works on and maintains spreadsheets by sorting/adding pertinent data.
• Analyze information contained within the billing systems to make decisions on how to proceed with the.
• Work independently and has the ability to make decisions relative to individual work activities.
• Identify…