What are the responsibilities and job description for the Medicare Billing Specialist, Full Time position at Hialeah Hospital?
Job Objective :
Under the direction of the Vice President of Revenue Cycle or designee, the Medicare Billing Specialist ensures all traditional Medicare and Medicare Managed Care claims are reviewed for claim edits, claim submission, and timely follow up, as assigned.
Duties and Responsibilities :
Review claims before submission for missing modifiers, charges, and / or implants.
Validate and make corrections on the UB04 resolving all claim edits before claim submission.
Ensure Medicare Managed Care no pay shadow claims are submitted to traditional Medicare.
Work suspended claims in the Medicare DDE system, as needed.
Validate pharmacy quantities are reflected on the claim correctly.
Validate claim against the coding abstract to ensure accurate billing of procedures.
Review 24 and 72-hour admission report combining claims, as needed.
Split inpatient claims as appropriate, per carrier guidelines.
Submit claims to carriers with the appropriate remarks and / or attachments.
Run insurance eligibility and correct claim before submission, as needed.
Pull supporting documents for annual regulatory audits, as needed.
Ensure Medicare credit balances are reviewed and resolved timely.
Ensure CMS Medicare Credit Balance Certifications are filed quarterly.
Other billing assignments, within skillsets and abilities.
Education
High School graduate or equivalent
Experience
Minimum 2-years Medicare billing experience in an acute care facility
Working knowledge of Common Procedural Terminology (CPT) and ICD10 Codes
Working knowledge of Federal, State, and Commercial billing guidelines
Location :
This position sits in our satellite office located in Westchester / Miami, FL
What Should I Know About Hialeah Hospital?
Our 378-bed acute care hospital opened in 1951 to serve the Hialeah, Florida community. Our team is committed to honoring the trust that our patients place in us by providing compassionate, safe, high-quality care in the right place, and at the right time.
Hialeah Hospital has been honored to receive a number of awards and designations for our superior health care services, including :
Cardiac
American Heart Association Get with the Guidelines - Heart Failure Gold Plus Award, 2018
American Heart Association Get with the Guidelines - Target Stroke Gold Plus Award, 2018
Bariatric
American College of Surgeons / American Society for Metabolic and Bariatric Surgery - MBSAQIP Accredited Center
BCBS Blue Distinction Specialty Care Bariatric Surgery, January 2018
Neurology
Advanced Primary Stroke Center Re-accreditation, April 2018
Women's Services
American College of Radiology granted Stereotactic Breast Biopsy Re-accreditation, March 2016
Hyperbaric Unit
Healogics Center of Distinction Award, 2017
Laboratory Services / Blood Bank
Certificate of Accreditation from College of American Pathologist
