Medicare Specialist, Remote
Medicare Specialist, Remote
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Primary Location:
Med Plaza II - UMCAddress:
250 E Liberty Louisville KY 40202Shift:
First Shift (United States of America)Job Description Summary:
Job Description:
This position requires thorough knowledge of the Uniform Bill Medicare and Medicare Advantage billing secondary deductible/coinsurance billing and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicare eligibility benefits determining primary payer and covered benefits.Additional Job Description:
- Monitor and resolve claims holding on discharged not final billed (DNFB) list.
- Assure all claims are filed electronically except for some paper claims.
- Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.
- Follow up on unpaid Medicare and Medicare Advantage claims in a timely manner.
- High dollar accounts will have consistent follow up until the account has been resolved.
- Responsible for reviewing and understanding explanation of benefits/remittance advice.
- Assure statements are generated for the patient responsibility amounts.
- Utilize insurance websites to view and resolve claims.
- Perform extensive account follow-up and provide analysis of problem accounts.
- Document all follow up efforts in a clear and concise manner into the AR system.
- Submit shadow claims to Medicare for inpatient Medicare Advantage payers.
- Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials
- Audit research accounts payment posting contractuals to confirm the accuracy of the balance of the account
- Adhere to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers.
- Assure medical record requests are documented and submitted in a timely manner
- Submit RAC correspondence to appropriate Denials/Appeals Specialist.
- Identify and report all trends that may provide insight into payment challenges.
- Phone contact with patient physician office attorney etc for additional information to process claims.
- Work assigned accounts as directed while reaching daily productivity goals.
- Complete tasks by deadline.
- Attend seminars as requested.
- Other duties as assigned.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
