Purpose Statement / Position Summary Medicare Biller, Senior is responsible for all Medicare billing of accounts to Fiscal Intermediary (FISS) to ensure that PFS is capturing all revenues as timely, efficiently and accurately as possible. The Medicare Biller, Senior utilizes many complex and varying regulations, guidelines and systems to perform Medicare billing functions. Proactively works with Fiscal Intermediary (FISS), patients and in-house resources to identify and resolve issues that delay account billing. Works under the supervision of management performing all tasks related to hospital reimbursement.
Essential Functions and Responsibilities of the Job
Ability to utilize patient billing software in performance of job functions.
Ability to accurately and timely request documentation needed from other departments to complete the billing process.
Ability to apply working knowledge of coding for accurate, timely billing reimbursement.
Demonstrates appropriate follow-up necessary resulting in expedient payment of billed charges.
Ability to recognize, share and apply knowledge of state and federal regulations in Medicare billing activities.
Able to be at work and on time, follow organization rules and procedures and directions from a Coordinator or other member of the Management staff.
At all times, provides professional and exceptional customer service and sets an example when interacting with all customers.
Able to adhere to all confidentiality policies and procedures and carries out all tasks in a pleasant and respectful manner.
Ability to make suggestions for and initiate enhancements throughout the department and continually seeks opportunities to improve current policies, procedures and practices.
Able to recognize and perform essential duties and offers assistance to others or performs other required tasks when own assignments are completed. Performs other duties as assigned by management.
Ability to use critical thinking while reviewing Medicare billing and collection notes in the financial computer system to ensure that the appropriate action is taken within the billing and collection process and to ensure correct hospital reimbursement.
Be at work and be on time
Follow company policies, procedures and directives
Interact in a positive and constructive manner
Prioritize and multitask
Essential Job Outcomes
Responds to insurance/departmental inquiries timely, effectively and accurately according to policies and procedures.
Documents all communications and patient/insurance demographics in the financial system ensuring detailed accuracy and necessary information to provide follow-up.
Working knowledge of HCPCS, CPT, ICD and revenue codes using appropriate manuals and resources, both hard-copy and online to facilitate billing.
Accurately and timely prepares and keys electronic and hard-copy billing; working rejects and other electronic reports daily; assists others, as requested.
Meets productivity goals as set by Management.
Knowledge of and appropriately applies state and federal regulations in Medicare billing activities using manuals and resources, both hard-copy and online, to initiate billing.
Makes suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures and practices.
Recognizes and performs essential duties and offers assistance to others or performs other required tasks, as assigned by management, when own assignments are completed.
“Other duties as assigned”
Minimum 3 year of experience and understanding of Medicare hospital billing processes, required
Current understanding and knowledge of Medicare payment methodologies, including OPPS, IPPS, IRFPPS, IPFPPS, APC, ASC, RBRVS, etc., required.
In depth knowledge of Medicare benefits, Part A, Part B, SNF, MA, MSP, Appeals Process, etc., required Current knowledge of Fiscal Intermediary (FISS) and Direct Data Entry (DDE)