Revenue Cycle Specialist - Medicare

Primarily responsible for generating billing cycles posting payments and follow-up on claims to ensure timely payment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Generates patient claims through EMR billing system. Upload EMC file to clearinghouse as soon after target bill date and errors/holds are clear. Continue review of unsubmitted claims to avoid timely filing errors.
2. Manage and hold claims waiting compliance review completion. Work with Revenue Cycle team to ensure billing compliance.
3. Review, key or follow up on 81A (NOE) prior to submission of initial claim. (if applicable to assigned duties)
4. Review, key or follow up on 815's, 817's and 818's when necessary.
5. Review and corrects RTP's in the DDE system on a regular basis.
6. Post Medicare PIP remittance advices through Clearinghouse auto post or manually when necessary.
7. Follows up regularly on unpaid claims by using DDE or phone call to PBGA service center for assistance or unresolved claim issues. Document response and any follow-up actions taken in EMR.
8. Work with the Dept. Director on Medicare credit balances to ensure compliance.
9. Work with other Hospice agencies to ensure smooth transitions between benefit periods and sequential billing.
10. Notifies the Dept. Director of any problems with claims or processes.
11. Assists other Revenue Cycle Specialist as needed to meet department goals.
12. Submit write off requests with documentation after all collection efforts have been exhausted to the Dept. Director.
13. Run admission report, assign and enter appropriate ICD-10 codes into EMR based on physician CTI. (if applicable to assigned duties)
14. Using pre-bill CPT audit sample to complete compliance review through physician coding compliance software. Report findings to appropriate Directors and CMO. (if applicable to assigned duties)
15. Report individual finds to the physician for review and resolution of the coding discrepancy. After physician review/approval make coding changes and note in EMR. Report to billing staff when claim can be released. (if applicable to assigned duties)
16. Other duties may also be assigned.

EDUCATION and/or EXPERIENCE

High School diploma required. One year college or technical school: one to three years related experience or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS

If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.