What are the responsibilities and job description for the Medicaid/Medicare Billing Specialist position at Hudson Regional Hospital?
Job Summary:
Responsible for the timely and accurate resolution of insurance claims, primarily for Medicare, Medicaid, and HMO plans. This role involves follow-up on claims from billing through final resolution, identifying and correcting errors, and ensuring prompt payment of outstanding accounts.
Key Responsibilities:
- Claim Follow-up:
- Monitor the progress of insurance claims from submission to payment
- Payers Include Medicare, Medicare HMO's, Medicaid and Medicaid HMO's
- Identify and resolve claim denials, rejections, and delays.
- Follow up with insurance carriers to expedite claim payments.
- Error Correction:
- Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.
- Make necessary corrections in the billing system to ensure accurate claims.
- Medicare Claims:
- Process Medicare RTP claims and denial reports on a daily basis.
- Ensure timely and accurate submission of Medicare credit balance quarterly reports.
- Account Resolution:
- Research outstanding accounts and take appropriate action to secure prompt payment.
- Analyze system-generated reports to identify accounts requiring research.
- Document all resolution activities in the appropriate system and log.
- Alert supervisors or managers of non-payment trends.
- Contractual Allowance:
- Research partial payments to determine if the appropriate contractual allowance was calculated.
- Initiate corrective action for miscalculated allowances, including collaboration with clinical departments.
- Document results and alert supervisors or managers of trends.
- Rejected and Denied Services:
- Research rejected or denied services and determine corrective action.
- Complete corrective action using departmental procedures and policies.
- Document results and alert supervisors or managers of non-payment trends.
- Reporting:
- Complete productivity reports and submit to supervisors within the established timeframe.
- Customer Service and Performance Improvement:
- Support the department's customer service and performance improvement goals.
- Collaborate with other staff to enhance patient care and service.
- Compliance:
- Maintain strict confidentiality of patient information.
Required Qualifications:
- Experience: 1-3 years of experience in healthcare billing or Hospital billing.
- Technical Skills: Proficiency in using billing systems and software.
- Knowledge: Knowledge of Medicare, Medicaid, and HMO billing regulations.
