We are American Healthcare Systems. Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

• Essential/stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
• Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance (bonuses only apply for Full Time).
• Comprehensive Employee Benefits: Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

Under the direction of the Director of Revenue Cycle or designee, the Medicare Billing Specialist ensures all traditional Medicare and Medicare Managed Care claims are reviewed for claim edits, claim submission, and timely follow up, as assigned.

PRIMARY RESPONSIBILITIES

• Review claims before submission for missing modifiers, charges, and/or implants
• Validate and make corrections on the UB04 resolving all claim edits before claim submission
• Ensure Medicare Managed Care no pay shadow claims are submitted to traditional Medicare
• Work suspended claims in the Medicare DDE system, as needed
• Validate pharmacy quantities are reflected on the claim correctly
• Validate claim against the coding abstract to ensure accurate billing of procedures
• Review 24 and 72-hour admission report combining claims, as needed
• Split inpatient claims as appropriate, per carrier guidelines
• Submit claims to carriers with the appropriate remarks and/or attachments
• Run insurance eligibility and correct claim before submission, as needed
• Pull supporting documents for annual regulatory audits, as needed
• Ensure Medicare credit balances are reviewed and resolved timely
• Ensure CMS Medicare Credit Balance Certifications are filed quarterly
• Other billing assignments, within skillsets and abilities

EDUCATION/EXPERIENCE

• High school graduate or equivalent; additional college training preferred
• Minimum 2 years medical billing experience, with emphasis on Managed Care and Government billing regulations.
• Working knowledge of Common Procedural Terminology (CPT) and ICD10 Codes
• Working knowledge of Federal, State, and Commercial billing guidelines
• Medical terminology required.
• Knowledge of contract terminology as it relates to healthcare
• Ability to communicate effectively, both verbally and in writing, with customers
• Ability to resolve problems with minimal assistance.
• Proficient in computer skills necessary to perform job duties.
• Strong interpersonal skills and organizational skills