What are the responsibilities and job description for the Billing Claims Analyst - Business Office position at Springhill Medical Center?
Hours Per Week: 40
We are seeking an experienced Billing Claims Analyst with extensive knowledge of UB-04 billing and Medicare regulations. This role is responsible for accurate claim submission, follow-up, and resolution of Medicare hospital billing issues to ensure timely reimbursement and compliance with CMS guidelines.
Pre-Employment Requirements:
- We are a drug free facility. Passing a pre-employment drug screening is required .
Education Requirements
- Must have a High School Diploma or GED.
- Coding certificate preferred.
Job Requirements:
- 5 - 10 years of hospital experience in 1500 and UB04 Billing, preferably Medicare.
- Recent working knowledge in Medicare Direct Data Entry (DDE) System.
- Proficiency navigating the WPS Medicare website, including ADRs, medical record uploads, appeals, and claim review
- In-depth knowledge of CMS Local Coverage Determinations (LCDs) related to hospital tests and procedures
- Experience calculating Medicare days (co-days, lifetime reserve days)
- Experience with Medicare edits, 72-hour overlap claims, clinical trials, and Hospice billing
- Ability to analyze, resolve, and appeal claim rejections and denials from Medicare, other payers, and clearinghouse
Qualifications
Licenses & Certifications
Required