CRITICAL ACCESS HOSPITAL - MEDICARE/MEDICAID BILLER/COLLECTOR SPECIALIST

The Medicare & Medicaid Biller/Collector Specialist will be responsible for the following…

• Insurance Claim preparation and submission
• Follow up on Medicare and Swing bed claims in Medicare DDE in a timely manner
• Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
• Review and resolve hospital and physician claims
• Identify payor issues proactively in relation to zero payment, payment variance, billing, and denials with a high degree of accuracy and report to Management
• Performs account follow-up on outstanding balances and takes the necessary action for account resolution in accordance with established federal and state regulations.
• Ensure the coordination of claim activities on various insurance portals and via phone to check claim status and resolve claim issues
• Research and resolve insurance denials
• Identify reason for claim rejections and complete proper action to ensure timely billing
• Able to read and understand an EOB
• Monitors and/or follows-up on Medicare and Medicaid accounts with precise documentation and calculations.
• Utilizes the previous documentation comments in order to follow up in the appropriate manner.
• Meet daily collection goals
• Resolve credit balances with insurance company timely and accurately
• Works with Coders to ensure accuracy of claims
• Knowledge of Medicare and Medicaid billing regulations ( Required)
• Experience with (Uniform Billing) UB-04 and (HCFA) 1500 claim forms billing and follow up functions - both electronically and manual.
• Knowledge of Medicare Secondary payer as well as medical necessity requirements ( Required)
• Detail oriented and able to handle multiple tasks