Medicare Billing Specialist


Terry Reilly Health Services is hiring for a Medicare Billing Specialist

GENERAL RESPONSIBILITIES     

   Responsible for processing claims to maximize collections on all patient accounts.

ESSENTIAL DUTIES

  • Manages patient information in practice management system as it relates to changes in patient's insurance coverage, including E-Med and Medicaid. Based upon verification of third-party insurance eligibility, transfer charges in the practice management system from one expected payor to another in order to generate accurate claims and statements.   Makes adjustments as appropriate for OB accounts after delivery and/or due to patient transfer of care. Makes other changes to patient billing information as requested by patient or staff.
  • Reviews third-party payor denials and determines appropriate course of action in order to collect on the account. Determines the reason for the denial and provides the insurer with the appropriate documentation for the claim to be paid. Follows-up with third party insurance carriers on unpaid claims until claims are paid or only self-pay balance remains.
  • Monitors ticket statuses on a weekly basis to ensure problems in billing are identified in a timely manner, corrects the problems, rebills claims to payors.
  • Tracks third-party payment amounts, pended claims numbers and amounts and has a general sense of payor denials to identify any potential cash flow problems with individual payors.       Through tracking these trends can identify problems, successes or inconsistencies of the major medical and dental payors; Medicare, Medicaid, Blue Cross (medical and dental), Blue Shield and Delta Dental.
  • Will successfully back up any position in the Patient Financial Services Department as needed. This will include but is not limited to third party payment posting, patient payment posting, contract billing for both TR and SANE, denials, account maintenance, OB package adjustments, hospital billing, return mail, refunds, etc.
  • Prepares aging reports for all medical, dental, and behavioral health programs. Processes refunds on insurance credit balance accounts only after reviewing and verifying accuracy of account. Generates refund request if appropriate and submits to Accounting department. Posts refund transactions approved by accounting department to patient account.
  • Handles patient and third-party carrier inquiries related to patient accounts.

MINIMUM QUALIFICATIONS

  • Minimum 2 years medical office experience with knowledge of diagnosis (ICD) and/or procedure (CPT) and/or dental (ADA) coding systems.
  • Demonstrated knowledge and understanding of Medicare, Medicaid and major insurance carrier regulations, procedures and benefit plans.
  • Two or more years’ experience billing third-party insurances.
  • Strong customer service skills..
  • Ability to effectively communicate and interact with physicians and coworkers, hospital staff, third-party payors, patients and the public.

For full job description and application information visit Terry Reilly Health Services Careers.

Terry Reilly Health Services is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

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