Medicaid/Medicare Billing Specialist
14 days ago
Clifton
Job Description Job Summary: Responsible for the timely and accurate resolution of insurance claims, primarily for Medicare, Medicaid, and HMO plans. This role involves follow-up on claims from billing through final resolution, identifying and correcting errors, and ensuring prompt payment of outstanding accounts. Key Responsibilities: • Claim Follow-up:, • Monitor the progress of insurance claims from submission to payment, • Payers Include Medicare, Medicare HMO's, Medicaid and Medicaid HMO's, • Identify and resolve claim denials, rejections, and delays., • Follow up with insurance carriers to expedite claim payments., • Error Correction:, • 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., • Medicare Claims:, • Process Medicare RTP claims and denial reports on a daily basis., • Ensure timely and accurate submission of Medicare credit balance quarterly reports., • Account Resolution:, • 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., • Contractual Allowance:, • 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., • Rejected and Denied Services:, • Research rejected or denied services and determine corrective action., • Complete corrective action using departmental procedures and policies., • Document results and alert supervisors or managers of non-payment trends., • Reporting:, • Complete productivity reports and submit to supervisors within the established timeframe., • Customer Service and Performance Improvement:, • Support the department's customer service and performance improvement goals., • Collaborate with other staff to enhance patient care and service., • Compliance:, • Experience: 1-3 years of experience in healthcare billing or Hospital billing., • Technical Skills: Proficiency in using billing systems and software., • Knowledge: Knowledge of Medicare, Medicaid, and HMO billing regulations.