Clinch Memorial Hospital
Clinch Memorial Hospital Human Resource Office
Homerville, GA 31634
United States

Manages Others
Experience Required
Degree Required
Accepts NHA Certifications
Security Clearance Required
Employment Type
Work Schedule
No Travel

Job Description

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

Job Requirements

GED or High School Diploma

This person MUST have extensive Critical Access Hospital Medicare and Medicaid insurance collection experience to apply.

Five (5) years of previous related healthcare Revenue Cycle experience, with a focus in Swing bed Billing and Collections REQUIRED.

Medicare DDE experience REQUIRED.

Certified Patient Account Representative (CPAR) certification preferred.

Knowledge of medical terminology, ICD and CPT codes.

***Must have Medicare and Medicaid follow up experience***
Clinch Memorial Hospital
Keith Bryant
Clinch Memorial Hospital 1050 Valdosta HIghway
Homerville GA 31634
United States