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Medicaid / Medicare Billing Specialist

Medicaid / Medicare Billing Specialist

Hudson Regional HospitalClifton, NJ, US
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Insurance Claims Resolution Specialist

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.

  • 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

    • Maintain strict confidentiality of patient information.

    Required Qualifications

  • 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.
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    Billing Specialist • Clifton, NJ, US