Inpatient Medicare & Medicaid Biller - Full Time Remote

About IKS Health   www.ikshealth.com

Job 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. Must have working knowledge of Medicare and the complex regulations concerning Medicare reimbursement. Strong customer service, good verbal and written communication, analytical skills to be able to ensure compliance with Medicare regulations and guidelines, maintain accurate records, and communicate effectively with various stakeholders.

Essential Duties and Responsibilities

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

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 and that they capture all charges and needed element to ensure prompt payment. 

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.

Ability to analyze claims data and identify discrepancies or errors and make necessary corrections in the billing system to ensure accurate claims.

Understand how to resolve Medicare/Medicare MA billing edits and/or warnings and billing edits that are identified in the Patient Accounting Billing System

Keep abreast of Medicare/Medicare MA government requirements and regulations and ensure all billing practices adhere to these standards.

Experience and knowledge with working the Medicare Quarterly Credit balance report and ensure  timely and accurate submission of Medicare credit balance quarterly reports.

 

Knowledge and understanding of:

The use of appropriate HCPCS, CPT 4 codes, MS-DRG, AP-DRG, Modifiers, POA and ICD10 codes and professional terminology.

The processing of the Inpatient Lifetime Reserved (LTR) notifications, rules and regulations

ABN's and the requirements when and how to appropriately bill claims for resolution

MSP (Medicare Secondary Payer) files

Billing TPL (Third Party Liability) claims and conditional billing

Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates

CMS Publication: 100-4 (Medicare Claims Processing Manual)

LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity

Ability to navigate and fully utilize Medicare Administrative Contactors (MACs) and CMS web sites

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 account.

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/Client departments the information needed to accurately bill.

Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments

Submit corrected and/or replacement 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 productivity and quality requirements as developed by Leadership as the team member is measured on high production levels, quality of work output, in compliance with established policy and standards

Follow up on unprocessed claims until a claims resolution is achieved

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