This position is responsible for maintaining relationships and being in constant contact with the financial intermediary, Medicare, Medicaid and payors to enable timely research and resolution of problems with patient billing. This person works to meet A/R targets and department measures to ensure successful and timely collection of payments and understand the core elements necessary for billing for specailty(ies) he/she bills.
Review industry transmittals and changes related to the specialties billed.
Monitor reimbursement and regulatory issues with Medicare, Medicaid and other third-party reimbursement.
Ensure compliance with industry standards, HIPAA Privacy, Federal and State regulations.
Processes secondary billing as needed.
Processes physician billing daily.
Processes State Medicaid forms and other information transactions.
Ensures accurate transmission of daily billing and electronic filing.
Utilizes online look-up and processing capabilities to monitor claims and resolve issues to expedite reimbursement.
Generates corrections and re-billing efforts if needed.
Enter write-offs or adjustments as appropriate.
Posts and reconciles all payments and ensures balancing posting back to accounting.
Monitors progress with aging reports and ensures timely follow up.
Build and cultivate relationships within primary pay sources to ensure issues are identified timely and resolved.
Works with insurance verification to resolve authorization issues.
Handles inquiries from patients, staff and nursing home providers regarding billing issues and problems.
Maintain any and all assigned billing responsibilities.
Maintain current knowledge of CMS regulations and changes.
Follows up and analyzes outstanding patient accounts and takes necessary action to clear the account.
Actively supports and complies with all components of the compliance program, including, but not limited to, completion of training and reporting of suspected violations of law and Company policy.
Maintains confidentiality of all information; abides with HIPAA and PHI guidelines at all times.
Reacts positively to change and performs other duties as assigned.
EMR system experience.
Excellent communication skills, both written and verbal.
Must be detail-oriented and self-directed.
Excellent customer service skills.
High school diploma required.
2-4 years of medical billing or other medical field-related experience, including Medicare, Medicaid and other-third parties required.
Physician billing experience desired.
We will only employ those who are legally authorized to work in the United States. Any offer of employment is conditional upon the successful completion of a background investigation and drug screen.
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