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Regional Medicare Billing Specialist
2 months ago
We are seeking a highly skilled and detail-oriented Regional Medicare Billing Specialist to join our team at LifeCare Home Health. As a key member of our revenue cycle team, you will be responsible for ensuring timely and compliant Medicare Home Health billing and reimbursement for our designated region.
Key Responsibilities- Collect and prepare all necessary information to prepare Medicare claims, coordinating with agencies as needed.
- Bill and submit clean claims to Medicare electronically and follow up with the Intermediary to ensure timely payment.
- Process, collect, and manage Medicare account payments, monitoring FISS daily and reporting totals for requested status locations.
- Research, correct, and re-submit rejected and denied claims, utilizing the revenue cycle management tool to follow up on corrections and report adjustments.
- Monitor and maintain assigned accounts, reviewing billing reports to maintain accurate AR balances and documenting all follow-up completed on claim outstanding balances until final resolution is reached.
- Keep accurate and orderly records for all billing and accounts receivable activity, performing pre-billing audits as assigned.
- Proactively identify potential reimbursement issues and ensure effective problem resolution, coordinating with the Agency and Billing Compliance Coordinator as needed.
- Report any billing issues that develop into trends to the immediate supervisor and answer questions from patients, agency staff, and insurance companies.
- Interpret and process Explanation of Benefits when needed, making outbound calls professionally while maintaining and improving customer relations.
- Report any Medicare credit balances each quarter.
- Required: Home health billing experience and Medicare billing experience.
- Preferred: Kinnser experience, AbilityEASE, and Palmetto GBA OPS experience.
- Ability to communicate effectively both verbally and in writing.
- Excellent customer service skills.
- Medicare and Managed Medicare billing and denial management skills.
- Excellent PC skills, including Medicare DDE (FISS), Email, Internet Research, Word Processing, Spreadsheets, PDF, and Patient Accounting software systems knowledge.
- Reviews and maintains reports and records to ensure accuracy.
- Knowledge in accessing the Medicare system, capable of direct edit and/or entry of claims.
- Claims preparation and audit, including prebill audits for billing compliance.
- Knowledge of Medicare Secondary Payer (MSP) regulations and claim submission.
- Detail oriented, effective in problem resolution and escalation.
- Able to organize duties and functions in a highly effective manner to achieve productivity and quality standards.
- Knowledge of CMS regulations and publications for Home Health Agencies.
- High school diploma or equivalent.
- Prolonged sitting, standing, and walking required.
- Ability to handle stressful situations in a calm and courteous manner at all times.
- Requires working under some stressful conditions to meet deadlines and Company needs.
