Highly Skilled Medicare and Medicaid Specialist

5 days ago


Ontario, California, United States Prime Healthcare Full time

Overview

Prime Healthcare is a leading health system headquartered in California, operating 45 hospitals and over 300 outpatient locations across 14 states. Our award-winning healthcare services provide more than 2.6 million patient visits annually, making us one of the nation's largest health systems.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.

Responsibilities

The Senior Medicare-Medicaid Specialist is responsible for both billing and collections, gathering and securing all information needed for billing, follow up, and payment of accounts in accordance with specific payer guidelines, policies, procedures, and compliance regulations for Medicare-Medicaid.

This includes maintaining deficiency lists used to obtain missing documents from internal or external entities, resolving claim rejections, packaging claims, including global billing with attachments of professional fee claims, performing proactive follow-up with payers and other entities, and securing payment of accounts.

The senior specialist is accountable and responsible for billing through account closure.

Qualifications

Educational Requirements

• Minimum of three years hospital managed care/commercial collector experience.

• 2 years of recent hospital Medicare billing experience in an automated environment.

• Associates degree or equivalent work experience required.

Knowledge and Skills

• Knowledge of contract interpretation.

• Familiar with hospital billing requirements.

• Knowledge of out-of-state Medicaid billing guidelines.

• Knowledge of basic Medicaid/Medicare billing rules, regulations, and deadlines.

• Working experience with all payer types, including commercial, governmental, Medicare, Medicaid, HMO, etc., and the ability to cross-over into different payers.

Salary and Benefits

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. This includes paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.

A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $21.00 to $42.56 per hour.



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