Medical Biller - Medicare

Job Family : PFS Billing

PFS Billing

Travel Required : None

None

Clearance Required : None

None

The Medicare Medical Biller is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims.

Must work with other departments to facilitate the meeting of both departmental and facility goals and objectives. Demonstrates an ability to find solutions to problems and keeps management informed of patterns regarding billing edits, compliance issues, payments and or other issues with specific payers.

Has an extensive knowledge of billing requirements mandated by payers and / or governmental regulations. This position will perform any and all related job duties as assigned.

This position is Hybrid working TWO Days in the San Marcos office and THREE Days from home.

Essential Job Functions

Medicare Billing Emphasis

Correcting and billing electronic and hardcopy claims

Submits Adjusted claims

Provides Follow-up Billing

Prepares Billing Reconciliation

Duties and Responsibilities

Performs daily download and reconciliation of claims from patient accounting system to electronic billing system.

Transmits or releases claims at a minimum daily.

Works all assigned claims daily by resolving edits, validating claim, or placing on departmental hold by reason.

Follows-up on all assigned held claims or unreleased claims.

Bills claims via electronic billing system.

Reviews same day and 72 hour admission report to determine if accounts needed to be combined.

Ensures all address changes and or plan changes are forwarded to the appropriate people so the integrity of the insurance master is maintained.

Files adjusted billings based on audits and or changes in diagnosis or DRG.

Updates patient accounts with corrected demographic or insurance information.

Works all rejection and payer audit reports within 48 hours of receipt taking whatever action may be required to obtain account resolution.

Monitors all denials for trends and issues and reports finding to supervisor.

Bills or re-bills as necessary.

Ensures hospital is in compliance with all state and federal rules and regulations both billing and HIPAA.

Assigned special projects will be completed within the time frames given.

Appropriately documents electronic billing system and / or patient accounting system.

Attends training sessions and seminars offered by the Hospital and Third Party Payers.

Handles all customer calls both internal and external in a professional and courteous manner.

Follows the mission statement and values established by the facility.

What You Will Need : High School diploma.

High School diploma.

0-2+ years billing or follow-up experience in Healthcare field or combination of billing and A / R follow-up.

What Would Be Nice To Have :

Emphasis in Medicare Billing

Emphasis in Hospital Billing

Excellent communication and interpersonal skills.

Experience with Excel and Word.

The annual salary range for this position is $37,600.00-$56,400.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer :

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include :

Medical, Rx, Dental & Vision Insurance

Personal and Family Sick Time & Company Paid Holidays

Position may be eligible for a discretionary variable incentive bonus

Parental Leave

401(k) Retirement Plan

Basic Life & Supplemental Life

Health Savings Account, Dental / Vision & Dependent Care Flexible Spending Accounts

Short-Term & Long-Term Disability

Tuition Reimbursement, Personal Development & Learning Opportunities

Skills Development & Certifications

Employee Referral Program

Corporate Sponsored Events & Community Outreach

Emergency Back-Up Childcare Program