Medicare Claims Specialist

4 days ago


Indianapolis, Indiana, United States CommuniCare Health Services Corporate Full time

About the Role:

The CommuniCare Health Services Corporate is seeking a skilled Medicare Claims Specialist to join our Central Billing Office in Cincinnati, OH. As a key member of our team, you will be responsible for billing, receivables auditing, and collections activities for services provided to patients in the facilities assigned.

Key Responsibilities:

  • Verify receipt of monthly triple check forms and audit for accuracy per triple check policy prior to claims submission
  • Review of Medicare A, Medicare A No Pays/Benefit Exhaust, Medicare B, and Medicare Secondary Payer claims for accuracy and timely submission per Medicare, Commercial, and Medicaid billing guidelines
  • Submission of Medicare Advantage Copy claims
  • Daily cash posting of Medicare and Secondary payments per Cash Postings policy
  • Follow-up on unpaid claims and document account within standard billing cycle time frame (Medicare: 16 days after submission , Commercial/Medicaid Coinsurance: 14-21 days after submission)
  • Monitor for and report Medicare additional development requests (ADR's) per process guidelines
  • Identify and submit necessary rebilling for secondary / tertiary claims during follow-up
  • Conduct account research and analysis
  • Submission of write offs for uncollectable accounts
  • Identify and create batches for necessary billing adjustments
  • Interact with facility staff to resolve outstanding issues
  • Participate in monthly A/R reviews
  • Participate in the month end close process.

About Us:

As a family-owned company, we have grown to become one of the nation's largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Our single job description at CommuniCare is 'to reach out with our hearts and touch the hearts of others.' Through this effort, we create 'Caring Communities' where staff, residents, clients, and family members care for and about one another.



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