Not Authorized
You are currently not authorized to access this section.
Please contact your Administrator to change your authorization settings.
Please contact your Administrator to change your authorization settings.
Medicare and Medicaid Billing Specialist, Day Shift, Full Time
Great Benefits Package! Rochelle Community Hospital operates as an independent and stable hospital.
Rochelle, IL
Job Description
GENERAL APPLICATION INFORMATION: Rochelle Community Hospital is an Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender, national origin, sexual orientation, age, marital status, medical condition, disability, protected veteran status, or any other legally protected status. No sponsorships available
ALL RESUMES AND APPLICATIONS NEED TO BE SUBMITTED THROUGH ILLINOISJOBNETWORK.COM TO BE CONSIDERED. Please be advised that your application is not complete until you fill out, sign, and submit an Application for Employment for a specific position for which Rochelle Community Hospital is actively recruiting. Your application must reflect that you possess the required qualifications for the position.
Position Summary:
Position reports directly to the Patient Financial Services Coordinator and is responsible for timely and accurate Medicare and Medicaid billing (including Managed Care Medicare-C / Medicaid MCO), follow-up, and payment reconciliation. Understands and follows guidelines for appropriate billing on UB04 and HCFA 1500 claim forms. Identify appropriate primary and secondary payers and ensure claims are billed appropriately. Understands and follows billing regulations as established by federal and state payers. Follow up on denied and/or un-paid claims to ensure account resolution. Coordinates billing and follow-up procedures with outsource agency performing Medicaid billing.
Duties and Responsibilities:
Position Qualifications:
Word Environment/Physical Demands
Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender identity, national origin, sexual orientation, age, marital status, medical condition, physical or mental disability, protected veteran status, or any other legally protected status.
ALL RESUMES AND APPLICATIONS NEED TO BE SUBMITTED THROUGH ILLINOISJOBNETWORK.COM TO BE CONSIDERED. Please be advised that your application is not complete until you fill out, sign, and submit an Application for Employment for a specific position for which Rochelle Community Hospital is actively recruiting. Your application must reflect that you possess the required qualifications for the position.
Position Summary:
Position reports directly to the Patient Financial Services Coordinator and is responsible for timely and accurate Medicare and Medicaid billing (including Managed Care Medicare-C / Medicaid MCO), follow-up, and payment reconciliation. Understands and follows guidelines for appropriate billing on UB04 and HCFA 1500 claim forms. Identify appropriate primary and secondary payers and ensure claims are billed appropriately. Understands and follows billing regulations as established by federal and state payers. Follow up on denied and/or un-paid claims to ensure account resolution. Coordinates billing and follow-up procedures with outsource agency performing Medicaid billing.
Duties and Responsibilities:
- Understand and follow Rochelle Community Hospital’s Standards of Excellence. Greet all guests utilizing excellent customer service. Display respect and dignity to patients, visitors and staff. Uphold hospital policies and maintains a code of confidentiality on all patient information.
- Welcomes patients and visitors to the hospital and interacts in a customer focused and compassionate manner to ensure patients and their representatives’ needs are met, that they understand their financial responsibility for services received, including charity care assistance program.
- Perform appropriately in difficult situations by remaining calm, notifying appropriate personnel and initiating appropriate action for patient accounts receivable resolutions.
- Assist payment processor in processing Medicare and Medicaid remittance advices to properly post payment and contractual allowances.
- Interpret Medicare and Medicaid requirements necessary to obtain proper payments in compliance with government billing regulations. Investigate potential charge/coding problems and forward recommendations to Manager for system updates according to CPT/HCPC and CCI edits. Investigate denials/edits for claim resolution. Insure patients are only billed for those balances of charges deemed their responsibility by posting contractual allowances. Coordinate efforts with HIM coding staff for denial investigations.
- Analyze receivable aging reports and work queues for claim resolution. Identifies potential problems and takes appropriate action on un-paid claims. Follows-up on unpaid claims to ensure all collection efforts are met prior to determining account balance is a self-pay portion.
- Follow Medicare bad debt regulations to identify accounts uncollectible. Record bad debt activity for audit purposes. Must remain knowledgeable of Medicare regulations by identifying and reporting only allowable amounts on the cost report as a bad debt. Rochelle Community Hospital is not a Method II provider, therefore professional fees are not to be reported in bad debt logs.
- Accurately prepares Medicare Quarterly Credit Balance report and coordinates with Manager and/or CFO to submit on a timely basis as defined by the Medicare MAC. Reviews credit balances on a regular basis. Analyzes if credit is due to incorrect posting of payment/contractual allowance or credit is to be refunded to third party payer or patient. Coordinates with patient account analyst to prepare appropriate paper work for credit balance refund as needed.
- Maintain third party logs in information system for designated payers according to established guidelines. Review logs for completeness, insures logs are accurate and ready for annual audit and cost report preparation.
- Coordinate with outside extended billing office for any information needed to accurately bill Medicaid claims. Acts as the liaison between PFS staff, Case management and HIM staff as needed for Medicaid billing.
- Accurately records patient telephone calls, patient and payer inquiries, collection activity and other account follow-up in hospital information system. Insure support documentation is scanned on account as needed.
- Participate in departmental training, in-services and education presentations as requested. Maintain CEU requirements for department as outlined in CEU policy. Must complete annual skills testing including MSP test to insure knowledge is complete to perform assigned duties. Acts as a resource to other billing personnel as it relates to government payers.
- Maintain required training and/or education per hospital guidelines. Follow and maintain all lawful safety, health requirements and regulations, and follow protocols for required protective equipment for peers, patients and community.
- Promptly report safety issues such hazardous conditions, job-related injury or illness, and seek guidance or treatment. Adheres to all professional standards, policies and procedures, federal/state/local requirements and regulatory organizations.
- Maintains strict confidentiality of patient and records. Portrays a professional and positive attitude for peers, patients and community
- Perform other duties as assigned.
Position Qualifications:
- High school graduate
- Proficient with computer use and related software including Microsoft Excel, Word, and Outlook
- Minimum three years of Medicare billing experience in a hospital setting (CAH preferred)
- General understanding of CPT and HCPCS codes as well as ICD-10 coding
- Ability to read and interpret new regulations related to governmental billing
- Two years EPIC experience (preferred)
- Must be able to take initiative and maintain accountability for actions
- Excellent verbal and written communication skills
- Visual and hearing acuity pertinent to communication with patients, visitors, and staff
- Ability to display a positive attitude when performing duties and handle conflict in an efficient and productive manner
- Ability to work both independently and in a time environment including ad-hoc projects
- Strong attention to detail and ability to stay task oriented while prioritizing workload
Word Environment/Physical Demands
- The ideal candidate must be able to work and complete all physical requirements of the job with or without a reasonable accommodation.
- Demonstrates the ability to work accurately and effectively in oral and written directions and communication.
- Enjoys working with people and works cooperatively with other hospital staff.
- Constant kneeling, stooping, bending, twisting and occasional need to lift patients
- Medium Lifting, generally lifting not more than 50 lbs. maximum with assistance, with frequent lifting and/or carrying of objects weighing up to 25 lbs.
Rochelle Community Hospital Association positions are guidelines. They are not intended to identify every task that an employee will be asked to do. They are intended to provide a general outline of the work, responsibility and qualifications of the position. Employees are expected to provide whatever assistance is needed so that both individual and organizational success can be achieved.
Equal Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, gender identity, national origin, sexual orientation, age, marital status, medical condition, physical or mental disability, protected veteran status, or any other legally protected status.
Special Notes/Instructions
All offers are contingent upon successful passing of a post-offer substance testing, positive reference checks and background check and your ability to establish your employment eligibility in the United States. RCH is a smoke-free campus.
Job Summary
Company
Employment Term and Type
Regular, Full Time
Hours per Week
40
Work Hours (i.e. shift)
8am - 4:30pm
Salary and Benefits
Competitive Pay based on experience, Paid Time Off (PTO), Paid Holidays, Paid Sick Leave, Shift Premiums, Health, Vision and Dental Insurance (eligible 1st of month after hire date), Life & Disability Insurance, 401(k) Plan, Flexible Spending Account, Employee Assistance Program, Free Fitness Center Membership, Employee Discounts, Education/Tuition Reimbursement, Career Advancement, Work/Life Balance Environment, Recognition and Rewards, Teamwork, Community-based
Required Education
High School or Equivalent
Required Experience
3+ years
Email this Job to Yourself or a Friend