Specialist Medical Claims - EvHealth

Responsible for maintaining for assigned accounts and business units, accurate, timely completion and review of medical billing claims. This includes re-submission of denials and re-billing items, to include status, research, follow up and resolution of claim. This involves interacting with various systems end to end in the revenue cycle process and the various personnel involved with those systems. Includes expertise in Home Health, Hospice and other related Home Care reimbursement services. Knowledge resource for Medicare and Medicaid billing requirements and the CMS DDE system.
Employee in this position may be assigned to train other employees. The employee performs diverse duties of an advanced and specialized nature.
Ensures effective reimbursement through efficient billing and claims resolution
Maintains comprehensive working knowledge of payer contracts and ensures that payers are billed according to contract provisions.
Maintains comprehensive working knowledge of government billing regulations including Medicare and Medicaid regulations and serves as a resource for appropriate organization personnel.
Monitors aged accounts receivable, researches RTPS and other denials. Resubmits bills to overdue accounts, submits seriously overdue accounts to collection agencies for collection, and prepares bad debt and charge off reports.
Reconciles Medicare quarterly reports produced by the fiscal intermediary with the billing information system, and assists in the preparation of the annual Medicare cost report as needed.
Maintains a comprehensive working knowledge of billing system including upgrades and enhancements.
Protects the confidentiality of patient and organization information through effective controls and supervision of billing operations.
Provides effective communication to patient/family, team members, and other health care professionals and maintains confidentiality
Adhere to all company policies and procedures.
Adherence to and compliance with information systems security is everyone's responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems.
High School Graduate or equivalency
Experience in the health care billing industry
Experience with billing systems preferred
Experience in health care collections preferred
Knowledge and Skills:
Two-to-six years' experience in health care billing and collections, home health and/or hospice specific operations required. Billing information systems knowledge required.
Knowledge of home health billing process for Medicare and private insurance billing practices.
Knowledge of home health and hospice coding system for billing processes.
Strong knowledge of Microsoft Excel.
Knowledge of corporate business management and governmental regulations.
Ability to establish and maintain effective working relationships with all segments of the staff, the lay and professional public and the field operations and clinical personnel.
Good customer Service skills
Basic computer knowledge
Good communication skills, written and verbal

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