Medicaid/Medicare Billing Specialist

Position Summary  

Responsible for accurately and efficiently processing insurance claims, primarily Medicaid, Medicare and Medicare and Medicaid HMO’s.

Job Duties

• Monitor the progress of insurance claims from submission to payment.
• Identify and resolve claim denials, rejections, and delays.
• Follow up with insurance carriers to expedite claim payments.
• Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.
• Make necessary corrections in the billing system to ensure accurate claims.
• Process Medicare RTP claims and denial reports on a daily basis.
• Ensure timely and accurate submission of Medicare credit balance quarterly reports.
• Research outstanding accounts and take appropriate action to secure prompt payment.
• Analyze system-generated reports to identify accounts requiring research.
• Document all resolution activities in the appropriate system and log.
• Alert supervisors or managers of non-payment trends.
• Research partial payments to determine if the appropriate contractual allowance was calculated.
• Initiate corrective action for miscalculated allowances, including collaboration with clinical departments.
• Document results and alert supervisors or managers of trends.
• Complete productivity reports and submit to supervisors within the established timeframe.
• Support the department's customer service and performance improvement goals.
• Collaborate with other staff to enhance patient care and service.
• Maintain strict confidentiality of patient information.
• Performs all other duties as assigned.

Qualifications and Skills

• Excellent customer service skills and problem solving skills.
• Strong analytical and organizational skills.
• Ability to interact with varying cultures and a diverse population.  
• Proficient in billing systems and software.  

Education, Experience and Certification/Licensure Requirements

• H.S. Graduate
• 1-3 years’ experience in hospital or healthcare billing
• Working knowledge of Medicare, Medicaid and HMO billing regulations.