Medicare/ Commercial Biller

Job DetailsJob Location: 2600 JOHNSTON ST - LAFAYETTE, LA 70503Position Type: Full TimeEducation Level: High SchoolTravel Percentage: NoneReports To: Revenue Cycle Manager

JOB DESCRIPTION SUMMARY

The Medicare / Commercial Biller oversees Medicare and private insurance billing operations, ensuring accuracy, compliance, and efficient collection processes.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Ensures accurate and timely filing of Medicare and private insurance claims, ensuring reimbursement in accordance with contract provisions and regulatory requirements.
Maintains a comprehensive understanding of Medicare and private insurance billing regulations, providing updates to the organization on relevant changes.
Monitors aged accounts receivable for Medicare and private insurance, resubmits overdue claims, and prepares bad debt reports as needed.
Collaborates with the Admissions team to ensure accurate processing of admission information for Medicare and private insurance claims.
Conducts research and processes claims to ensure compliance with Medicare and private insurance guidelines.
Electronically imports payments from all pay sources and accurately posts them to the financial system.
Reconciles payments and ensures the system is prepared for monthly accounting closeout.
Identifies and resolves issues related to payment processing, claim denials, and system errors.
Updates billing rates and uploads data to the Suncoast system on a daily basis.
Completes and submits Notice of Election forms in compliance with regulatory requirements.
Communicates with patients, families, and pay source representatives to address and resolve claim processing issues.
Coordinates with external facilities to facilitate patient transfers, admissions, discharges, and certification period updates.
Assumes the responsibilities of the Revenue Cycle Manager during their absence, ensuring continuity of operations.
Collaborates with clinical teams to compile and complete required reports.
Manages patient pay collections for HOA and PMOA.
Oversees month-end closing procedures and prepares reports for the Revenue Cycle Manager.

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks or special projects, other than those stated in this description, by supervisors/Leadership Team. 

 QualificationsPOSITION QUALIFICATIONS

Education: High School Diploma or equivalent.
Experience: Minimum of three (3) years in healthcare billing or collections, with expertise in Medicare regulations. Knowledge of Suncoast, Ability, and/or Waystar preferred.
Skills: Strong time management, attention to detail, familiarity with medical terminology, and understanding of insurance codes and Medicare/private insurance requirements.