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Medicare Billing and Follow-up Representative
2 months ago
Chesapeake Regional Healthcare is seeking a highly skilled and detail-oriented Medicare Billing and Follow-up Representative to join our team. As a key member of our revenue cycle department, you will be responsible for ensuring the compliant, accurate, and timely billing and follow-up of all hospital Medicare and Medicare Advantage Patient Accounts.
Key Responsibilities- Submit Medicare/Medicare Advantage plan claims to the appropriate government and non-government payers, both electronically and on paper.
- Understand and resolve Medicare/Medicare MA billing edits and/or warnings, as well as billing edits identified in the Patient Accounting Billing System.
- Keep abreast of Medicare/Medicare MA government requirements and regulations, and ensure compliance with all relevant laws and guidelines.
- Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.
- Process rejections by correcting any billing error and resubmitting claims to government and non-government payers.
- Place unbillable claims on hold and properly communicate with various Hospital departments to ensure accurate billing.
- Perform the billing of complex scenarios, such as interim, self-audit, combined, and split billing.
- Limit the number of unreleased claims by reviewing all imported claims and either billing or holding the claim for further review.
- Meet Billing and Follow-up productivity and quality requirements as developed by Leadership.
- Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met.
- Follow up on unprocessed or unpaid claims until a claims resolution is achieved.
- Generate letters to insurance or patients as needed to resolve unpaid claim issues.
- Work independently and make decisions relative to individual work activities.
- Identify comments in the billing systems using initials and approved abbreviations for universal understanding.
- Keep documentation clear, concise, and to the point, while including enough information for a clear understanding of the work performed and actions needed.
- Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation.
- Read, understand, and explain benefits from all payers to coworkers, physicians, and patients.
- Develop relationships with customers/patients/co-workers to gather and process information or resolve issues to receive accurate reimbursement and optimize internal and external customer satisfaction.
- Post accurate adjustments as appropriate per billing policies and procedures, payer explanation of benefits, and the management directive.
- Maintain work procedures pertinent to the job assignment.
- Accountable for individual work activities.
- Resolve questions that arise regarding correct charging and/or other concerns regarding services provided.
- Complete cross-training, as deemed necessary by management, to ensure efficient department operations.
- Report potential or identified problems with systems, payers, and processes to the manager in a timely manner.
- CRCS Certification and/or College degree preferred in health care or business related field or High school diploma is significant with years of patient revenue cycle/process experience in lieu of college degree.
- 5 plus years in a Hospital setting with extensive background in hospital billing and follow-up functions.
- Must exhibit very strong analytical and compliance skills.
- Applicants must be a Certified Revenue Cycle Specialist (CRCS) upon hire or within twelve months of the start date.
