Job Information
Chesapeake Regional Healthcare Billing Follow Up Medicare in Chesapeake, Virginia
The Medicare Billing and Follow-up Representative are responsible for the compliant, accurate and timely billing and follow-up of all hospital Medicare and Medicare Advantage Patient Accounts.
Essential Duties and Responsibilities
Duties and responsibilities described represent the general tasks performed on a daily basis, but not limited as other tasks may be assigned.
Submit Medicare/Medicare Advantage plan claims both electronic and paper claims ( UB -04 and 1500) to the appropriate government and non-government payers
Submit shadow bill (Information only claims) to Medicare
Understand how to resolve Medicare/Medicare MA b illing edits and/or warnings and billing edits that are identified in the Pat i ent Accounting Billing System
Knowledge of working F .I.S.S.(Florida Institutional Shared System) in order to resolve Medicare claim issues
Keep abreast of Medicare/Medicare MA government requirements and regulations .
Understand ABN’s and the requirements when and how to appropriately bill claims for resolution
Experience and knowledge with working the Medicare Quarterly Credit balance report
Experience in ICD -10, CPT-4 and HCPC professional terminology
Knowledge and understanding regarding the processing of the In -Patient lifetime reserved notifications, rules and regulations
Knowledge and understanding working MSP (Medicare Secondary Payer) files
Knowledge and understanding billing TPL (Third Party Liability) claims and conditional billing
Current knowledge of Medicare Transmittal, Change Requests and the ability to understand and interpret Monthly CMS News Updates
Understands LCD (Local Coverage Determination) and NCD (National Coverage Determination) and how it relates to medical necessity
Ability to navigate and fully utilize Medicare Fiscal Intermediary (Palmetto GBA) and CMS websites
Understanding of the CMS Publication: 100-4 (Medicare Claims Processing Manual)
Ensures claim information is complete and accurate in order to maximize the clean claim rate resulting in claim resolution and payment for complex billing and payment issues
Analyze inform ation contained within the Patient Accounting and Billing system to make decisions on how to proceed with the billing of an account.
Processes rejections by correcting any billing error and resubmit t ing claims to government and non-government payers .
Place unbillable claims on hold and properly communicate to va rious Hospital departments the information needed to accurately bill.
Process late charge claims in the event that charges are not entered in a timely fashion by Hospital Departments
Submit corrected claims in the event that the original c la im information has changed for various reasons
Perform the billing of complex scenarios such as interim , self - audit , combined , and split billing etc.
Limit the number of unreleased claims by rev i ewing all imported claims and either billing or holding the claim for further review
Meet Billing and Follow-up productivity and quality requirements as developed by Leadership
Measured on high production leve ls , quality of work output , in compliance with established CRH ' s policy and standards
Review patient financial records and/or claims prior to submission to ensure payer-specific requiremen ts are met
Keep abreast of payer-specific and government requirements and regulations
Follow up on unprocessed or unpaid c l aims unti l a c l aims resolution is achieved
Generates letters to insurance or patients as needed in order to resolve unpaid claim issues.
Works on and maintains spreadsheets by sorting/adding pertinent data
Analyze information contained within the billing systems to make decisions on how to proceed with the account.
Work independently and has the ability to make decisions relative to i ndividual work activities
Identify comments in the billing systems by using in i tials and using approved abbreviations for universal understanding
Keep documentation clear , concise , and to the point , while including enough information for a clear understanding of the work performed and actions needed
Create appropriate documentation , correspondence , emails , etc . and ensure that they are scanned to the proper account for accurate documentation
Read , understand , and explain benefits from all payers to coworkers , physicians , and patients
Make phone calls , use the internet , and send mail to payers for follow-up on unprocessed claims , incorrectly processed claims , or claims in question
Develop relationships with customers / patients / co-workers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction
Post accurate adjustments as appropriate per bill i ng policies and procedures , payer explanation of benefits , and the management directive
Maintain work procedures pertinent to the job assignment
Accountable for individual work activities
Resolve questions that arise regarding correct charging and / or other concerns regarding services provided
Complete cross-training , as deemed necessary by management , to ensure efficient department operations
Report potential or identified problems with systems , payers , and processes to the manager in a timely manner .
Education and Experience
Education:
High School Diploma with significant years of patient revenue cycle/process experience in lieu of college degree
CRCS Certification and or College Degree preferred
Experience: 5 years in a Hospital setting with extensive background in hospital billing and follow-up functions.
Must exhibit very strong and/or been engaged in analytical and compliance issues.
Certificates, Licenses, Registrations
Applicants must be a Certified Revenue Cycle Specialist (CRCS) upon hire or within twelve months of the start date.
