Pfs Representative Iii - Medicare Biller Job at Tucson Medical Center (Tucson)

Job Description

Medicare Billing Specialist: Performs complex review and reconciliation of Medicare patient accounts. Communicates with Medicare regulatory or, state agencies, related to Medicare billing, collection or refund activities. Works independently to resolve problems and demonstrates complete understanding of payer requirements to ensure timely and accurate payment. Completes reconciliation and billing of accounts making independent decisions based on situations. Works directly with Finance Director on any Medicare payment discrepancies and works directly with Compliance on CMS Regulatory requirements. Additionally, works with Health Information Management (HIM) on coding issue and local coverage determination (LCD) issues.

Job Responsibility

Performs complex review and reconciliation of Medicare patient accounts
Communicates with Medicare regulatory or, state agencies, related to Medicare billing, collection or refund activities
Works independently to resolve problems and demonstrates complete understanding of payer requirements to ensure timely and accurate payment
Completes reconciliation and billing of accounts making independent decisions based on situations
Works directly with Finance Director on any Medicare payment discrepancies and works directly with Compliance on CMS Regulatory requirements
Works with Health Information Management (HIM) on coding issue and local coverage determination (LCD) issues
Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows
Ensures UB04 and HCFA 1500 claims and/or self-pay patient accounts are billed in a timely, complete, and accurate manner in accordance with appropriate guidelines
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence
Demonstrates understanding of the entire revenue cycle
Provides routine daily internal and external interface with unit/department management and staff, other service areas, information systems, physicians, physicians’ office staff, patients, software/hardware vendors, and third-party payers in order to resolve patient concerns, disputes, and billing audits in order to receive payment
Assists with problem solving, inquiries, and customer interaction to ensure positive results
Researches and analyzes any correspondence received related to assigned accounts
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication
Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable
analyzes and processes contractual write offs
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards
Ensures patient accounts are refunded and/or billed in a timely, complete, and accurate manner in accordance with payer contracts and payer guidelines, and/or billing and follow-up guidelines
Prepares and enters contractual write-offs and dispute letters to Medicare or insurance carriers as required
Serves as information resource to patients and hospital staff regarding credit and collection policies or Medicare polices and benefits
Analyzes and prepares commercial/Medicaid payer claim denial reconsiderations and or formal disputes as needed on non-clinical denials based on payer guidelines
Follows up on all appealed claims assigned, escalating as needed based on appeal levels with the payer
Maintains online payer resource reference library related to payer policies utilized for follow up and or appeals
Reviews/analyzes payer driven denial reason codes to determine root cause of the denial
Submits recommendations to Management on any identified trends in order to assist in reducing denials
Trains and assists in the implementation of new software programs/systems and related technologies
Performs related duties as assigned

Requirements

High School diploma or General Education Degree (GED)
Three (3) years of related experience, specific to role specialty such as medical billing or third-party collection, or customer service in a hospital, payer, or physician setting
Technical experience in CMS/Medicaid regulations and/or commercial payer billing requirements
Minimum three (3) years’ experience in a windows environment, including Excel
Relevant professional certification encouraged within 2 years
Knowledge of medical insurance practices and policies and regulations
Knowledge of HMO, PPO, and Indemnity third party billing guidelines
Knowledge of either UB04 hospital or CMS physician billing forms
Knowledge of government and non-government uniform billing guidelines
Knowledge of medical terminology and coding Related to hospital billing and/or professional billing such as revenue, CPT diagnosis codes, modifiers, occurrence codes, value codes, and the appropriate usage of these codes
Skill in evaluating bills/claims for payers or patients in order to collect payment in a timely manner
Skill in providing assistance or training to other staff members in a team environment
Skill in the use of computer applications and systems including: Excel, Word, Internet, email, and miscellaneous programs and networked computer systems
Ability to read and comprehend instructions, short correspondence, and memos
Ability to write correspondence
ability to effectively present information in one-on-one and small groups situations to customers, clients, and other employees of the organization
Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations
Ability to effectively present information and respond to inquiries or complaints from payers, patients and/or their representatives
Ability to demonstrate familiarity of the components of a medical chart in order to supply appropriate chart documentation to various payers as required
Ability to identify any trends related to their assigned payer in order to escalate to management or provider representative
Ability to read and interpret payer explanations of benefit documents
Strong analytical and critical thinking abilities in order to make sound decisions
Ability to demonstrate compliance with all state and federal regulations for managed care and third-party payers
Ability to handle higher complexity accounts
Self-starter with ability to research independently

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Pfs Representative Iii - Medicare Biller

Job Description

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