[Hiring] Medicare Biller and Analyst @ANDERSON HOSPITAL

Role Description

Bills Medicare claims for Anderson Healthcare as an organization excluding Anderson Medical Group. Reviews and analyzes unpaid claims, determining action steps for follow-up and claim resolution. Processes payor denials and resubmits corrections to resolve denials. Processes and resolves credit balances. Processes claim edits, as well as late and lost charges. Processes Medicare Return-To-Provider requests. This position has the potential to work remotely per the PFS policy requirements, once training has been met and employee has leadership approval.

Job Responsibilities

• Bills all Medicare claims regardless of patient status or bill type.
• Bills claims accurately and in compliance with Medicare and other payor regulations and guidelines.
• Reviews and analyzes all Medicare RTP’s (Returned to Providers), as well as other claim statuses in the XDirect software, taking the appropriate action to complete and expedite claim payment.
• Reviews and analyzes unpaid aging Medicare claims utilizing Meditech automated reminders. Determines current account status, and determines necessary action steps to expedite claim payment by Medicare. Utilizes Explanations of Medicare benefits in the analysis of account status. Escalates problem accounts to team leadership.
• Reviews and analyzes applicable Medicare denials in the Denials Manager software application, determining necessary action to correct and resubmit claim or other necessary claim resolution.
• Reviews and analyzes all Medicare credit balances and takes necessary action to accurately and compliantly resolve the credit balance.
• Reviews and analyzes all Medicare and other assigned claim group late and lost charges and determines necessary action to bill or adjust charges in compliance with hospital policy.
• Participates in department education regarding Medicare and changes and standards, and maintains a current knowledge of Medicare billing requirements.
• Identifies and recommends opportunities for process improvement in Patient Financial Services, or other Revenue Cycle departments, as related to the PFS processes.
• Other Job Duties as assigned.

Qualifications

• High school diploma or equivalent.
• Previous experience in Medicare billing preferred.
• Knowledgeable in CMS Medicare regulations and guidelines preferred.
• Knowledgeable in the use of Direct Data Entry [DDE] processes preferred.
• Previous experience in Medicare follow-up and/or denials processing preferred.
• Previous experience in hospital patient accounts experience preferred.
• Office procedures and keyboarding minimum 50 wpm preferred.
• Microsoft Word and Excel experience preferred.
• Other computer and organizational skills preferred.
• Meditech experience helpful.