Medicare Billing Specialist

Position Overview

We are looking for a motivated performer to join the Centralized Training Office as a Hospital Billing Specialist focused on Medicare. We are looking for a top performer with extensive knowledge of billing processes. Reporting to the Billing Manager, the Hospital Billing Specialist, Medicare is responsible for the timely and accurate submission of claims ensuring those claims result in maximum reimbursement.

This will encompass services rendered in an Acute Care Surgical Hospital setting.

• Pull any preoperative notes from the designated transcription company.
• Extract information from medical records, operative notes, invoices, progress notes and discharge paperwork to ensure completeness and accuracy of charge entry.
• Capture implants, high-cost supplies, high-cost drugs, post op pain blocks and observations times prior to charge submission
• Review accuracy of invoice details, including customer billing instructions, pricing, discounts, state sales tax, etc.
• Execute the recurring billing workflow and generate and transmit claims daily.
• Ensure timely follow-up and resolution of internal and external inquiries of billing issues (i.e., operative notes, POPM form, invoices, or implant pricing etc).
• Reconcile revenue and billing during the period-end close process.
• Complete accurate charge entry for all assigned cases and upload to designated electronic claims clearinghouse daily.
• Resolve claim rejections daily to ensure clean claims are transmitted and received by the appropriate payer.
• Investigate, appeal, and resolve denied or unpaid claims, ensuring correct resubmission and payment.
• Navigate the DDE and make the appropriate claims corrections when appropriate.
• Manage claim resubmission queues in a timely manner.
• Maintain current knowledge of health care billing laws, rules, regulations, and developments.
• Complete Special Projects when appropriate.
• Complete other duties as assigned.

• Experience in DDE system, Ability Ease, and Novitasphere
• 3-4 years previous Hospital billing experience, with emphasis on Medicare billing
• Preference shown to previous experience in a Facility setting
• Ability to work independently
• Excellent communication skills and interpersonal skills
• Skilled in time management and prioritization of emergent situations
• Comfortable utilizing critical thinking skills
• Proficient with Microsoft Office products
• Experience with electronic patient information systems
• Function as a subject matter expert (SME) for Medicare
• Experience with Ability, DDE, nThrive, Cerner, etc required.