What are the responsibilities and job description for the Medicaid Coinsurance Biller position at CommuniCare Health Services?
CommuniCare Health Services is currently recruiting a Medicare Coinsurance Biller for our Central Billing Office in West Virginia. This position will ideally work in our Charleston, WV office located at 700 Chappell Rd, but it can also be remote, and we are accepting candidates from all over, not limited to West Virginia!
Qualifications / Experience Requirements
Qualifications / Experience Requirements
- Knowledge of Medicare & Secondary Billing Guidelines
- Medicare experience required.
- SNF experience preferred.
- Previous experience billing various Medicare and Co-insurance companies and understanding the requirements for each payor
- Claims appeal/resolution expertise preferred
- 2 - 4 years advanced education beyond high school, or comparable work experience
- Strong verbal and written skills are required in order to interact with insurance companies to resolve unpaid claims via telephone and written correspondence
- Professional appearance and mannerisms
- Ability to work as part of a team
- Computer skills including, but not limited to Microsoft Word, Excel, and Outlook
- Knowledge of Medicare DDE, e-Solutions, Point Click Care and Quadax preferred
- Verify receipt of monthly triple check forms and audit for accuracy per triple check policy prior to claims submission
- Review of Medicare A, Medicare A No Pays/Benefit Exhaust, Medicare B, and Medicare Secondary Payer claims for accuracy and timely submission per Medicare, Commercial, and Medicaid billing guidelines
- Submission of Medicare Advantage Copy claims
- As Medicare payment occurs, identify and submit billing for secondary claims that do not automatically crossover to secondary insurance
- Daily cash posting of Medicare and Secondary payments per Cash Postings policy
- Follow-up on unpaid claims and document account within standard billing cycle time frame (Medicare: 16 days after submission, Commercial/Medicaid Coinsurance: 14-21 days after submission)
- Monitor for and report Medicare additional development requests (ADR’s) per process guidelines
- Identify and submit necessary rebilling for secondary / tertiary claims during follow-up
- Conduct account research and analysis
- Submission of write offs for uncollectable accounts
- Identify and create batches for necessary billing adjustments
- Creation and submission of cost Report Bad Debt write offs for states assigned to Medicare CBO, per Medicaid billing guidelines
- Accurately prepare and maintain various reports to include: Monthly Cash Report & Shortage Explanation, Triple Check Audit, Credit Balance Report
- Interact with facility staff to resolve outstanding issues
- Participate in monthly A/R reviews
- Participate in the month end close process.
- Other various duties as assigned
