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Role Description

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.

• 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

• High School Diploma, or GED
• 1 year of patient registration, billing or equivalent experience
• Working knowledge of medical and insurance terms is desirable.

Requirements

• 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.