Medicare Billing Specialist - AM Health Systems

We are American Healthcare Systems. Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

• Essential/stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
• Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance (bonuses only apply for Full Time).
• Comprehensive Employee Benefits: Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

Under the supervision of the Director of Revenue Cycle or designee, performs patient account follow-up, credit balance review and resolution, keeping the hospital's accounts receivable as accurate as possible.

PRIMARY RESPONSIBILITIES

• Insurance follow-up, as assigned
• Contact insurance carriers regarding outstanding balances until resolution
• Resubmit claims with the appropriate remarks and/or attachments as needed
• File insurance reconsideration letter for payment and/or denial disputes
• Validate accounts for accurate payments, discounts, and contractual adjustments
• Reply to insurance carrier correspondence as appropriate
• Run insurance eligibility and correct claim before resubmission as needed
• Pull supporting documents for annual regulatory audits, as needed
• Ensure credit balance and refund requests are reviewed and resolved timely
• Answer in-coming calls resolving patient and/or insurance issues timely
• Assist with other duties as assigned, within skill sets and abilities

EDUCATION/EXPERIENCE

• High school graduate or equivalent; additional college training preferred
• Minimum 1-year Commercial, HMO, PPO, and Workers Compensation billing and/or
• Insurance follow-up experience
• Working knowledge of HMO, PPO, Commercial, and Workers' Compensation reimbursement
• Working knowledge of Managed Care contract language and interpretation
• Knowledge of contract terminology as it relates to healthcare
• Ability to communicate effectively, both verbally and in writing, with customers
• Ability to resolve problems with minimal assistance.
• Proficient in computer skills necessary to perform job duties.
• Strong interpersonal skills and organizational skills