Insurance Billing Specialist for Patient Services

2 weeks ago

Fort Lauderdale, Florida, United States Catholic Health Services Full time

Position Overview

The Insurance Billing Specialist is accountable for the billing and prompt follow-up of all assigned Medicaid claims for healthcare facilities, ensuring a cost-effective and efficient process. Effective management of accounts receivable relies on collaboration with the business office and admissions staff, as well as adherence to various governmental regulations.

Key Responsibilities

  • Conduct monthly billing for Medicare inpatient and outpatient claims related to nursing facilities and rehabilitation centers.
  • Reconcile monthly Medicare bills with the billing recap generated from the KEANE software to ensure accuracy across all facilities.
  • Generate accounts receivable aging reports for appropriate payers post month-end close to facilitate follow-up efforts.
  • Oversee annual billing for vaccinations across all facilities.
  • Provide daily updates on expected cash receipts from Medicare, maintaining a comparison spreadsheet for monthly billing recaps.
  • Review the Aged Trial Balance to identify claims exceeding 90 days and ensure timely resolution.
  • Analyze Return to Provider (RTP) claims to identify errors and communicate necessary changes to prevent future occurrences.
  • Examine recurring editing trends to modify Medicare billing specifications and reduce redundancy in corrections.
  • Participate in cross-training initiatives within the department to enhance overall team knowledge and cohesion.
  • Audit accounts with Medicare denials to resolve outstanding balances.
  • Accurately input information from various sources to amend claims related to CPT and ICD-10 codes, ensuring timely submission to Medicare.
  • Follow up on all outstanding claims that are over 30 days old to ensure resolution.
  • Maintain strong working relationships with counterparts in business, admissions, case management, and medical records to support effective revenue cycle management.
  • Utilize departmental systems and tools, identifying and reporting any systemic issues that may lead to payment delays or revenue loss.
  • Manage ISNP billing and follow-up by running reports for various charges to facilitate data entry for charge posting.
  • Conduct monthly billing and follow-up for all Hospice claims.

Additional Responsibilities

  • Perform other duties as assigned by the Revenue Cycle Manager.
  • Maintain required licenses, certifications, and skill updates.
  • Adhere to all relevant policies and regulations.
  • Engage in other assigned tasks as necessary.

Supervisory Role

  • This position does not have direct supervisory responsibilities.

Disclaimer

This job description is intended to provide a general overview of the position and is not an exhaustive list of all responsibilities and duties that may be assigned.

EEOC Statement

Catholic Health Services is committed to providing equal employment opportunities and prohibits discrimination and harassment of any kind.

Qualifications

  • High school diploma with two years of relevant experience or a combination of education and training.
  • Proficient in computer systems, calculators, and office equipment.
  • Familiarity with clinical software and the ability to read, write, and comprehend English.
  • Knowledge of DDE, PDPM, and Medicare B.
  • Ability to interpret and communicate Medicare Benefits.
  • Understanding of Medicare A/B eligibility and entitlement details.

Physical Requirements

  • Ability to lift and/or move up to 25 pounds, with occasional lifting of up to 50 pounds.
  • Work in an office environment with moderate to loud noise levels.
  • Frequent interruptions may occur.
  • Work schedule may extend beyond typical hours, including weekends and holidays.
  • Hand dexterity is required for data entry tasks.

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