Billing Specialist II - Medicare

Job Summary

Processing of claims, via electronic claims management system, by reviewing identified errors or rejections and resolving these issues appropriately. Also responsible for completing requests for rebilling of denied claims.

Essential Functions

• Reviews the system account display of demographics, billing, balance, balance prorations, and other pertinent account information for accuracy and completeness prior to generation of bill.
• Displays knowledge of mainframe system to look for special instructions and/or appropriate procedures prior to billing.
• Initiates daily downloads and monitors claims in the electronic system ensuring that all downloads are complete and accurate. Displays knowledge of systems.
• Demonstrates ability to analyze reasons for failure of transmission.
• Performs system account maintenance where necessary to reflect current account status and conform account data to intended and structured use of automated patient accounting system, as appropriate in assigned area.
• Assembles billing documentation on billing in assigned area submitted via hard copy; reviews and initiates corrections to assure accuracy.
• Submits paper claims on the same day a claim becomes billable. Modifications to claims data is made when necessary to ensure accuracy of claims.
• Identifies reasons for incomplete, erroneous charges or rejection of special accounts; researches and coordinates their resolution.
• Demonstrates ability to analyze reasons for rejected claims and fix. Seeks assistance of supervisor when necessary.
• Takes corrective actions to eliminate or minimize delays in billing and updates department with corrective actions.
• Initiates billing, rebilling and/or split billing when appropriate to pursue expedient processing of claim for payment of assigned accounts, as appropriate in area of responsibility. Billing or rebilling of rejected claims are consistently done within one day of receiving the claims rebill. Demonstrates ability to split a billing when appropriate.
• Responds to incoming telephone or written inquiries from other departments for information on accounts. Provides a response within two working days and acknowledges the inquiry if there is not a response within two days.
• Maintains all reports within the billing department on a daily basis or as needed basis.
  Reviews the Failed Claim Requirements to allow claims to be submitted to the electronic system erroneously.
• Communicates with other departments for correct information.
  Maintains complete and updated knowledge of revenue codes, Healthcare Common Procedure Coding (HCPC) codes, Current Procedural Terminology (CPT), and all billing guidelines.
• Maintains complete knowledge of combining accounts when necessary for billing purposes.
  Demonstrates knowledge of mainframe system and ability to analyze claims to fix.
• Maintains complete knowledge of all Billing requirements and forms used for any billing corrections. Demonstrates a working knowledge of payors for billing requirements.
• Recognizes deficiencies and provides mentorship and assistance to coworkers when needed with minimal supervisory assistance. Demonstrates a willingness to assist coworkers. Working relationships are regarded as positive. Works toward completion of goals/objectives.
• Maintains knowledge of third party billing regulations, as well as the utilization of applicable automated resources for assigned area of responsibility.
  Reviews related materials and attends in-services as directed to maintain current knowledge of applicable regulations. Continues professional growth by attending specific department in-services.
• Remains up-to-date on regulatory issues and/or developments impacting area of responsibility.
  In the event information is needed from another source/department in order to resolve an edit on the patient bill, request form is processed within one day of identification. Tracks actively to ensure claim resolution is done within one week.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree preferred
• 1-3 years Related work experience required
• 2+ years of Medicare and Managed Medicare experience preferred
• 2+ Direct Data Entry (DDE) experience preferred

Knowledge, Skills and Abilities

• To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheet software and E-mail software