Prepares and submits hospital, hospital-based physician and Rural Health Clinic claims to Medicare either electronically or in DDE
Secures needed medical documentation required or requested by Medicare
Follows up with Medicare on unpaid claims till claims are paid or only self-pay balance remains.
Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to Medicare or third-party insurance carriers.
Responsible for consistently meeting production and quality assurance standards.
Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer.
Updates job knowledge by participating in company offered education opportunities.
Protects customer information by keeping all information confidential.
Processes miscellaneous paperwork.
Ability to work with high profile customers with difficult processes.
May regularly be asked to help with team projects.
Ensure all claims are submitted daily with a goal of zero errors.
Timely follow up on insurance claim status.
Reading and interpreting an EOB (Explanation of Benefits).
Respond to inquiries by insurance companies.
Denial Management.
Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles.
Review reports identifying readmissions or overlapping service dates and ignore, merge, or split-bill according to the payer’s rules and the client’s policy.
Review credit reports, resolve credits belonging to a payer when able, and submit a listing of credits to the facility as required by the payer.
Minimum Requirements:
Education/Experience/Certification Requirements
· At least 3 years’ hospital billing experience, can include time outside of TruBridge
· Medicare DDE experience required
· Experience in CPT and ICD-10 coding preferred
· Experience in filing claim appeals with insurance companies to ensure maximum reimbursement preferred
· Excellent communication (written and oral) and interpersonal skills.
· Strong organizational, multi-tasking, and time-management skills.
· Must be detail oriented and able to follow through on issues to resolution.
· Must be able to act both independently and as a team member.
· High School Diploma or equivalent combination of education and relevant experience needed.
· Excellent critical thinking, organizational, and time management skills with a strong attention to detail, accuracy, and follow through
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