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Medicare Claims Specialist
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We are seeking a highly skilled Medicare Billing Specialist to join our team at American Healthcare Systems. As a key member of our revenue cycle team, you will be responsible for ensuring accurate and timely submission of Medicaid and Medicaid Managed Care claims.
Key Responsibilities:
- Review and validate claims for accuracy and completeness before submission
- Resolve claim edits and discrepancies in a timely manner
- Verify pharmacy quantities and ensure accurate billing of procedures
- Split inpatient claims as necessary, following carrier guidelines
- Submit claims to carriers with supporting documentation and remarks
- Run insurance eligibility checks and correct claims as needed
- Pull supporting documents for annual regulatory audits
- Ensure timely resolution of Medicaid credit balances
Requirements:
- High school graduate or equivalent; additional college training preferred
- Minimum 2 years Medicaid billing experience, with emphasis on Managed Care and Government billing regulations
- Working knowledge of CPT and ICD10 codes, as well as Federal, State, and Commercial billing guidelines
- Medical terminology and contract terminology knowledge
- Excellent communication and problem-solving skills
- Proficient in computer skills necessary for job duties
About Us:
At American Healthcare Systems, we are committed to providing high-quality healthcare services to our patients and their families. We offer a stable and growing work environment with opportunities for training and advancement.
