Billing Follow Up Medicare

The Medicare Billing and Follow-up Representative are responsible for the compliant, accurate and timely billing and follow-up of all hospital Medicare and Medicare Advantage Patient Accounts. **Essential Duties and Responsibilities** Duties and responsibilities described represent the general tasks performed on a daily basis but not limited as other tasks may be assigned. * Submit Medicare/Medicare Advantage plan claims both electronic and paper claims (UB-04 and 1500) to the appropriate government and non-government payers * Submit shadow bill (Information only claims) to Medicare * Understand how to resolve Medicare/Medicare MA billing edits and/or warnings and billing edits that are identified in the Patient Accounting Billing System * Knowledge of working F.I.S.S. (Florida Institutional Shared System) in order to resolve Medicare, claim issues * Keep abreast of Medicare/Medicare MA government requirements and regulations. * Understand ABN's and the requirements when and how to appropriately bill claims for resolution * Experience and knowledge with working the Medicare Quarterly Credit balance report * Experience in ICD-10, CPT-4 and HCPC professional terminology * Knowledge and understanding regarding the processing of the In-Patient lifetime reserved notifications, rules and regulations * Knowledge and understanding working MSP (Medicare Secondary Payer) files * Knowledge and understanding billing TPL (Third Party Liability) claims and conditional billing * Current knowledge of Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates * Understands LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity * Ability to navigate and fully utilize Medicare Fiscal Intermediary (Palmetto GBA) and CMS web sites * Understanding of the CMS Publication: 100-4 (Medicare Claims Processing Manual) * Ensures claim information is complete and accurate in order to maximize the clean claim rate resulting in claim resolution and payment for complex billing and payment issues * Analyze information contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account. * Processes rejections by correcting any billing error and resubmitting claims to government and non-government payers. * Place unbillable claims on hold and properly communicate to various Hospital departments the information needed to accurately bill. * Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments * Submit corrected claims in the event that the original claim information has changed for various reasons * Perform the billing of complex scenarios such as interim, self-audit, combined, and split billing etc. * Limit the number of unreleased claims by reviewing all imported claims and either billing or holding the claim for further review * Meet Billing and Follow-up productivity and quality requirements as developed by Leadership * Measured on high production levels, quality of work output, in compliance with established CRH's policy and standards * Review patient financial records and/or claims prior to submission to ensure payer-specific requirements are met * Keep abreast of payer-specific and government requirements and regulations * Follow up on unprocessed or unpaid claims until a claims resolution is achieved * Generates letters to insurance or patients as needed in order to resolve unpaid claim issues. * Works on and maintains spreadsheets by sorting/adding pertinent data * Analyze information contained within the billing systems to make decisions on how to proceed with the account. * Work independently and has the ability to make decisions relative to individual work activities * Identify comments in the billing systems by using initials and using approved abbreviations for universal understanding * Keep documentation clear, concise, and to the point, while including enough information for a clear understanding of the work performed and actions needed * Create appropriate documentation, correspondence, emails, etc. and ensure that they are scanned to the proper account for accurate documentation * Read, understand, and explain benefits from all payers to coworkers, physicians, and patients * Make phone calls, use the internet, and send mail to payers for follow-up on unprocessed claims, incorrectly processed claims, or claims in question * Develop relationships with customers/patients/co-workers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction * Post accurate adjustments as appropriate per billing policies and procedures, payer explanation of benefits, and the management directive * Maintain work procedures pertinent to the job assignment * Accountable for individual work activities * Resolve questions that arise regarding correct charging and/or other concerns regarding services provided * Complete cross-training, as deemed necessary by management, to ensure efficient department operations * Report potential or identified problems with systems, payers, and processes to the manager in a timely manner. **Education and Experience** Education: CRCS Certification and or College degree preferred in health care or business-related field or High school diploma is significant with years of patient revenue cycle/process experience in lieu of college degree. Additional specialized training relevant to job responsibility. Experience: 5 plus years in a hospital setting with extensive background in hospital billing and follow-up functions. Must exhibit very strong and/or been engaged in analytical and compliance issues. **Certificates, Licenses, Registrations** Applicants must be a Certified Revenue Cycle Specialist (CRCS) upon hire or within twelve months of the start date.