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Medicare Medical Biller

2 months ago

North Lauderdale, United States Catholic Health Services Full time

**MUST HAVE EXPERIENCE WITH MEDICARE BILLING**

**On site M-F (North Lauderdale corporate office)


Summary & Objective

Responsible for the billing and timely follow up of all assigned Medicaid claims for Nursing Home and Hospital in a cost effective and efficient manner. Successful accounts receivable management is predicated on working closely with nursing home and hospital business office and admissions staff, as well as the various governmental regulatory agencies (i.e., DCF).


Essential Functions

  • Monthly billing of Medicare inpatient/outpatient claims for nursing facilities and rehabilitation hospitals
  • Reconciliation of monthly bills sent to Medicare compared to the monthly billing recap generated from the KEANE software for total billings for all nursing facilities and rehabilitation hospitals.
  • Run all AR aging reports for appropriate payers after Keane month end close to use as a follow up tool. Work accounts, old to new and high to low dollar.
  • Annually oversee charges and billing of vaccinations for all facilities.
  • Daily reporting of expected cash receipts from Medicare as reported on the DDE system. Updating of this spreadsheet for the monthly billings in order to compare cash receipts from Medicare to the monthly billing recap by facility.
  • Review of the Aged Trial Balance to identify all claims over 90 days and proper and timely resolution of those claims.
  • Review of Return to Provider (RTP) claims and analysis of errors on those claims to prevent recurrence of same errors. Communication to Director for changes that need to be made to the KEANE software or bill specification of Medicare so that changes can be made timely and accurately.
  • Analysis of recurring editing trends so that modification of Medicare bill specification can be accomplished to prevent redundancy of corrections during the bill editing process.
  • Cross training on other systems/processes within the CBO in order to gain a well rounded knowledge of the department thus leading to a more cohesive team.
  • Audits accounts showing Medicare denials to resolve balances.
  • Accurately enter information provided by various sources to correct claims in regard to CPT and ICD-10 codes and send out results in a timely manner to Medicare.
  • Follow up on all outstanding claims greater than 30 days.
  • This includes the successful resolution of all claims in a timely and cost effective manner.
  • Maintain close working relationship with facility counterparts in business office, admissions office, case management office, medical records office, etc. to ensure effective revenue cycle management.
  • Utilization of all departmental system tools (i.e., KNS; Ability; etc.). In addition identify and communicate any and all systemic issues that may result in payment delays, underpayments, lost revenue, etc.
  • ISNP Billing/Follow up- Runs reports from ECS software for varies charges (i.e. Vaccines: Medical Supplies: Blood Glucose Monitoring etc.) to submit for data entry for charge posting.
  • Monthly billing and follow-up for all Hospice claims (via invoice)


Other Duties

  • All other duties as assigned by the Revenue Cycle Manager.
  • Maintain your required license, certifications and mandatory skill updates.
  • Comply with all policies, local, state and federal laws and regulations.
  • Perform other duties as assigned.


Knowledge & Experience Requirements

  • High school diploma and two years related experience of a combination of education and training.
  • Must be knowledgeable with computers, calculators, system applications, spreadsheets and other related office equipment.
  • Must have knowledge of computer office/clinical software
  • Must be able to read, write and understand the English language
  • Must have knowledge of DDE, PDPM and Med B
  • Must be able to interpret and communicate Explanation of Medicare Benefits.
  • Must have knowledge of Medicare A/B Eligibility, Entitlement details and Medicare Secondar Payer (MSP)


Disclaimer

The job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.


EEOC Statement

CHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.