Billing and Collection Specialist - Medicare

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OCCUPATIONAL SUMMARY

Bills and collects on Medicaid/Medicare accounts in a timely and accurate manner.

PRIMARY DUTIES AND RESPONSIBILITIES

General

1. Prepares standardized, uniform, or customized claim forms to all Medicaid/Medicare and CMO carriers in a timely and accurate manner.
2. Maintains current status in billing daily downloads as well as completing referrals, late charges and returned claims from coding and audit accurately and within the required timeframe.
3. Maintains current working knowledge of universal billing regulations and requirements as well as individual Northside Hospital
4. Maintains current status in ATB as well as completing collections referrals accurately and within the required timeframe.
5. Maintains monthly collection goal minimum standards of 95%.
6. Prepares daily, weekly, and monthly production reports by the required deadline.
7. Takes the initiative to solve problems and inquiries on individual accounts; referring serious problems to lead or Supervisor.

Billing Office – Medicare/Medicaid Billing

In addition to the items listed above in Section A, Billing Clerks assigned to the Medicare/Medicaid Billing function in the Billing Office are responsible for the following:

1. Reviews and prepares UB-92 and HCFA-1500 claim forms for submission to Medicare, Medicaid, and Champus in a timely and accurate manner.
2. Maintains current status with daily billing download as well as all secondary claims, cross-over forms and referrals from other departments.
3. Reviews, corrects and follows up on all Medicare claims via the Florida Shared System maintaining an acceptable status.
4. Maintains a current working knowledge of all changes in billing guidelines and regulations for Medicare, Medicaid and Champus.
5. Works with other departments to resolve billing issues and ensure compliance with all Government regulations.
6. Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Immediately reports any mechanical or electrical equipment malfunctions, unsafe conditions, or employee/patient/visitor injury‑accident to Manager.

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION REQUIRED

1. One (1) year experience in billing, OR Associate's Degree in Business.
2. Good verbal communication skills and basic typing ability.

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION PREFERRED

1. S. degree in Business or Accounting.
2. Two (2) years experience in insurance billing, or related area.
3. Prior hospital or healthcare experience.
4. Demonstrated knowledge of electronic billing systems