Onsite​/Hybrid Inpatient Medicare & Medicaid Biller

Onsite / Hybrid Inpatient Medicare & Medicaid Biller

Join to apply for the Onsite / Hybrid Inpatient Medicare & Medicaid Biller role at IKS Health
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The Medicare Biller is responsible for the compliant, accurate and timely billing of all hospital Medicare and Medicare Advantage (Medicare HMOs) patient accounts. This role requires a strong understanding of Medicare billing processes, regulatory compliance, and the ability to manage multiple tasks effectively. The position involves identifying and correcting errors to ensure prompt payment of outstanding accounts, and maintaining accurate records while communicating with stakeholders.

• Generate and submit claims, both electronic and paper claims (UB-04 and HCFA-1500), ensuring adherence to billing guidelines and regulations.
• Review patient financial records and claims prior to submission to meet payer-specific requirements.
• Review unreleased claims daily, resolve and release to the payer.
• Examine 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.
• Handle requests in all designated billing queues daily and complete secondary claim releases.
• Submit shadow bill (IME/Information only claims) to Medicare.
• Process Medicare Return to Provider (RTP) claims and denial reports daily.
• Analyze claims data, identify discrepancies or errors, and correct them in the billing system.
• Resolve Medicare/Medicare MA billing edits and warnings using the Patient Accounting Billing System.
• Stay updated on Medicare/Medicare MA government requirements and regulations, ensuring all billing practices adhere to standards.
• Work the Medicare Quarterly Credit balance report and ensure timely, accurate submission of Medicare credit balance quarterly reports.
• Use appropriate HCPCS, CPT‑4, MS‑DRG, AP‑DRG, modifiers, POA and ICD‑10 codes and professional terminology.
• Process Inpatient Lifetime Reserved (LTR) notifications, rules, and regulations.
• Handle ABN’s and bill claims for resolution appropriately.
• Manage MSP (Medicare Secondary Payer) files, TPL (Third‑Party Liability) claims, and conditional billing.
• Process Medicare Transmittal, Change Requests, and interpret Monthly CMS News Updates.
• Utilize MACs and CMS websites to support billing operations.
• Ensure claim information is complete and accurate to maximize clean claim rate.
• Analyze information in Patient Accounting and Billing system to decide on account billing actions.
• Process rejections by correcting billing errors and resubmitting claims to government and non‑government payers.
• Place unbillable claims on hold and communicate required information to Hospital/Client departments.
• Calm late charge claims when charges are not entered timely by Hospital Departments.
• Submit corrected or replacement claims when original claim information changes.
• Handle complex scenarios such as interim, self‑audit, combined, and split billing.
• Limit unreleased claims by reviewing imported claims for billing or hold status.
• Meet billing productivity and quality requirements as set by leadership.
• Follow up on unprocessed claims until resolution.
• Generate letters to insurers or patients to resolve unpaid claim issues.
• Make calls, use payer or third‑party vendor portals, and mail to payers for follow‑up on unprocessed claims.
• Maintain proper work procedures relevant to the job assignment.
• Complete cross‑training as required by management.
• Identify opportunities to improve business results and alert business units of trends or anomalies.
• Maintain close working relationships with facility counterparts for effective revenue cycle management.

• 2–5 years in a hospital setting, with at least 1 year background in Medicare hospital billing and follow‑up functions.
• Experience with electronic health records and medical billing software.
• Strong analytical and compliance skills.
• Knowledge of hospital billing requirements;
  Medicare billing rules, regulations, and deadlines.
• Knowledge of revenue cycle management best practices.
• Ability to manage multiple tasks efficiently.

The pay range for this position is $18 to $22 per hour. Compensation is based on factors such as market conditions, location, education, experience, and certifications. IKS Health offers a competitive benefits package, including healthcare, 401(k), and paid time off (subject to eligibility requirements for full‑time employees). IKS Health is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

Mid‑Senior level

Full‑time

Other – Hospitals and Health Care