Medical Billing Specialist

Medical Billing Specialist is responsible for the complete and accurate billing and collections of all hospice claims submitted for payment to third party payers including, but not limited to, Medicare, Medicaid, Managed Care, commercial carriers, and any other state and federal health care programs. Performs all follow up duties associated with rebilling, adjustments, corrected claim submissions and collections of all overdue accounts/claims in accordance with best business practices. Must be able to work on-site in the Corporate Miramar, Florida office Monday-Friday. Hybrid schedule.

• Meets established daily productivity standards.


• Schedule and download the daily bill job files and processes for transmittal.


• Research, correct, and re-submit rejected and denied claims.


• Responsible for timely billing whether by paper or electronic claim in the appropriate claim format.


• Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner- knowledge of questions to ask for proper processing.


• Responsible for identifying problems and solutions or enhancements to resolve billing issues including, but not limited to, billing frequency, required forms, and general billing requirements.


• Identify problem accounts and escalate as appropriate.


• Update the patient account record to identify actions taken on the account.


• Manages clearinghouse and payor accept/reject reports timely while ensuring all claim rejections are resolved within 72 hours of rejection occurrence.


• Logs repetitive errors or exceptions and reports them to management to ensure the admission record and related systems are properly updated and corrected.


• Coordinates with collectors and management to become familiar with the changing demands and requirements of payers in each state.


• Interacts with other areas and departments to troubleshoot and resolve issues that may not have standard documented solutions.


• Provide support to the Collectors by producing timely, accurate and complete billing documents.


• Stays abreast of changes in all editing processes as may be required.


• Acts as a resource for billing information and assists collectors and other staff members in producing any special documentation which may be required.


• Identify coding or billing problems from EOBs and work to correct the errors in a timely manner.


• Understands and serves and as subject-matter expert for billing specifications and requirements of assigned payers and states


• Understand Hospice Notice of Election (NOE) submission timing requirements and exceptions.

QUALIFICATIONS

• Three to four years prior experience in a general office environment (accounting or billing experience in a healthcare environment preferred)


• Knowledge of insurance billing guidelines including Medicare, Medicaid, and other third party payers.


• Possess a full understanding of the health care collections and reimbursement process, and an in depth knowledge of the insurance industry.


• Ability to work on various assignments simultaneously


• Strong interpersonal skills within all levels of the organization


• Ability to navigate within automated systems and proficiency in Outlook, Word and Excel 

EDUCATION

• Completion of high school or basic education equivalency required.

SPECIAL INSTRUCTIONS TO CANDIDATES

• EOE/AA M/F/D/V