• Completes timely claim submission, denial management, payment variance, and accounts receivable resolution.
• Imports, edits, corrects and transmits hospital claims on a daily basis.
• Ensures activity is fully documented related to claim submission, follow-up and resolution in hospital systems.
• Investigates and/or refers to management systemic billing issues that cause delays in reimbursement.
• Identifies administrative denials by working denial work-items and through remittances; follows through with appeal or corrective action to obtain claim payment.
• Applies payor acceptance reports and 277 reports to manage payor rejections and take appropriate action for resolution.
• Applies appropriate HOLDS and subsequently releases claims based on billing requirements, coding needs and data deficiency.
• Reports HELD claims to management.
• Manages 72-hour billing compliance and provides reports as directed.
• Provides billing documentation (UB, IB) as requested.
• Confirm claim receipt, remittance, or additional information required for claim resolution within established timing thresholds.
• Prepares daily claims submission tracking and pending authorization reports.
• Reviews and identifies potential front-end errors to avoid payor delays and provides necessary feedback to points of registration and management.
• Monitors, researches and communicates front-end CMS Medical Necessity denials.
• Assists with implementing billing system upgrades.
• Works with internal and external customers to implement billing system upgrades.
• Maintains/identifies Payor ID Alias(s) to maximize and expedite electronic billing processes
• Coordinates with departments to confirm correct and timely coding information.
• Coordinates within department and outside department to resolve issues related to billing/claim submission.
• Collaborates with Patient Access, Patient Financial Services/Clearance, HIM, Case Management, IT, and any other relevant departments to determine revisions needed for registration quality, charge corrections, claim submission, and accurate reporting

REQUIREMENTS:

• Education: HS Diploma/GED preferred
• Experience: 2 to 4 years of medicare claims, follow up and billing experience, Training is on site for minimum of 90 days so candidates must be local.

Key Words

Governmental Billing

Medicare

Medicaid

Claims Processor

Billing Specialist

Facility billing