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Billing Follow Up Medicare

Company: Chesapeake Regional Healthcare
Location: Chesapeake
Posted on: June 12, 2021

Job Description:

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

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.

Keywords: Chesapeake Regional Healthcare, Chesapeake , Billing Follow Up Medicare, Other , Chesapeake, Virginia

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