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

Generates letters to insurance or patients as needed in order to resolve unpaid claim issues.

Analyze information contained within the billing systems to make decisions on how to proceed with the account; ability to identify and resolve billing issues. 

Work independently and have the ability to make decisions relative to individual work activities

Keep documentation clear, concise, and to the point, while including enough information for a clear understanding of the work performed and actions needed

Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation

Make phone calls, use payer or third party vendors portals, and send mail to payers for follow-up on unprocessed claims, incorrectly processed claims, or claims in question

Maintain work procedures pertinent to the job assignment

Complete cross-training, as deemed necessary by management, to ensure efficient department operations

Proactively identify opportunities to improve business results and/or to alert business units of trends, anomalies or health plan rules and decisions that need attention; report potential or identified problems with systems, payers, and processes to the manager in a timely manner

Maintain close working relationships with facility counterparts for effective revenue cycle management.

Education and Experience

Experience:  2-5 plus years in a hospital setting with at least 1 year background in Medicare  and Medicaid hospital billing and follow-up functions required. 

Experience with electronic health records and medical billing software. 

Must exhibit very strong analytical and compliance issues skills.

Knowledge of hospital billing requirements;  Medicare and Medicaid billing rules, regulations, and deadline (Understands the billing and payment follow up time limits set forth by Medicare)

Knowledge of revenue cycle management best practices.

Ability to manage multiple tasks effectively and efficiently.

Compensation and Benefits: The pay range for this position is $18 to $22 per hour. Pay is based on several factors, including but not limited to current market conditions, location, education, work experience, certifications, etc.  IKS Health offers a competitive benefits package including healthcare, 401(k), and paid time off (all benefits are 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.