Medicare Billing Specialist, Full Time

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 equivalentExperience

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 guidelinesWhat 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:CardiacAmerican Heart Association Get with the Guidelines - Heart Failure Gold Plus Award, 2018American Heart Association Get with the Guidelines - Target Stroke Gold Plus Award, 2018BariatricAmerican College of Surgeons/American Society for Metabolic and Bariatric Surgery - MBSAQIP Accredited CenterBCBS Blue Distinction Specialty Care Bariatric Surgery, January 2018NeurologyAdvanced Primary Stroke Center Re-accreditation, April 2018Women's ServicesAmerican College of Radiology granted Stereotactic Breast Biopsy Re-accreditation, March 2016Hyperbaric UnitHealogics Center of Distinction Award, 2017Laboratory Services/Blood BankCertificate of Accreditation from College of American Pathologist