A/R Medicare Specialist

3 weeks ago

Louisville Kentucky, United States UofL Health Full time
Overview:
WE ARE HIRING
Location: 250 E Liberty Street Louisville, KY 40202 

About UofL Health 
UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.  Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to (url removed).
 

Job Summary:

This position requires thorough knowledge of the Uniformed Bill, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the DDE system for follow up.   Performs all duties related to timely and efficient billing and follow-up.  Thorough understanding of Medicare eligibility, benefits, determining primary payer, and covered benefits.

Responsibilities:
Monitor and resolve claims holding on discharged not final billed (DNFB) list.

Ensure all claims are filed electronically except for some paper claims.

Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.

Follow up on unpaid Medicare and Medicare Advantage claims in a timely manner.

High dollar accounts will have consistent follow up until the account has been resolved.

Responsible for reviewing and understanding explanation of benefits/remittance advice.

Ensure statements are generated for the patient responsibility amounts.

Utilize insurance websites to view and resolve claims.

Perform extensive account follow-up and provide analysis of problem accounts.

Document all follow up efforts in a clear and concise manner into the AR system.

Submit shadow claims to Medicare for inpatient Medicare Advantage payers.

Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials

Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account

Adhere to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers.

Ensure medical record requests are documented and submitted in a timely manner

Identify and report all trends that may provide insight into payment challenges.

Phone contact with patient, physician office, attorney, etc for additional information to process claims.

Work assigned accounts as directed while reaching daily productivity goals.

Complete tasks by deadline.

Attend seminars as requested.

Other duties as assigned.

Qualifications:
MINIMUM EDUCATION & EXPERIENCE

High School Diploma, or GED

1 year of patient registration, billing or equivalent experience

Working knowledge of medical and insurance terms is desirable.

KNOWLEDGE, SKILLS, & ABILITIES

Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies.

Knowledge of general insurance requirements.

Experience working directly with EOBs and contractual adjustments.

General computer knowledge, working with electronic filing.

Ability to communicate verbally/in writing with professionalism.

Ability to meet productivity expectations.

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