Medicaid/Medicare Billing Specialist

Position Summary

Responsible for accurately and efficiently processing insurance claims, primarily Medicaid, Medicare and Medicare and Medicaid HMO’s.

Job Duties

Monitor the progress of insurance claims from submission to payment.

Identify and resolve claim denials, rejections, and delays.

Follow up with insurance carriers to expedite claim payments.

Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.

Make necessary corrections in the billing system to ensure accurate claims.

Process Medicare RTP claims and denial reports on a daily basis.

Ensure timely and accurate submission of Medicare credit balance quarterly reports.

Research outstanding accounts and take appropriate action to secure prompt payment.

Analyze system-generated reports to identify accounts requiring research.

Document all resolution activities in the appropriate system and log.

Alert supervisors or managers of non-payment trends.

Research partial payments to determine if the appropriate contractual allowance was calculated.

Initiate corrective action for miscalculated allowances, including collaboration with clinical departments.

Document results and alert supervisors or managers of trends.

Complete productivity reports and submit to supervisors within the established timeframe.

Support the department's customer service and performance improvement goals.

Collaborate with other staff to enhance patient care and service.

Maintain strict confidentiality of patient information.

Performs all other duties as assigned.

Qualifications and Skills

Excellent customer service skills and problem solving skills.

Strong analytical and organizational skills.

Ability to interact with varying cultures and a diverse population.

Proficient in billing systems and software.

Education, Experience and Certification/Licensure Requirements

H.S. Graduate

1-3 years’ experience in hospital or healthcare billing

Working knowledge of Medicare, Medicaid and HMO billing regulations.