Government Billing Specialist
RCS - Billing | Frontera Crossing Office, ATX | Full Time
- Responsible for the accurate submission of claims to Medicare, Medicaid, Tricare and other government payers in accordance with payer billing and compliance policies and Federal billing regulations.
- Ensures coding accuracy of submitted claims to payers, the following includes: proactive review of claims, support with re-submissions, re-works, claims communications, reconsiderations, rejections and appeals support.
- Ensures coding compliance standards are supported and works closely with charge entry personnel, clients, payers, outside agencies, patients and family members as needed.
- Responsible for assisting with the system's update testing, coding library maintenance, preparing payer specific form types and training as necessary.
- Reviews and analyzes all errored claims for correct coding and insurance billing guidelines prospectively and retrospectively.
- Validates UB04 and HCFA 1500 claims formatting and data requirements based on Medicare, Medicaid, and other government payer regulations to assure appropriate reimbursement is received and all compliance standards are met and maintained.
- Verifies UB04 CPT coding to Health Information Management's coding summary; applies coding and charges to correct Revenue Code lines, bill types and other requirements as appropriate.
- Supports edits and rejections of transmitted claims to government payers.
- Analyzes all outstanding unbilled government claims and reports findings
- Follows up with Medicare, Medicaid, Tricare and other government payers to investigate unpaid claims; submission changes and appeals as needed.
EDUCATION AND EXPERIENCE:
- Minimum 7+ years of experience as a Patient Billing Specialist preferred.
- Minimum 3+ years of experience as a Governmental Biller in a facility setting preferred.
- Experience with DRG payment methodlogy
- Active Certified Coder credential required (Professional and Facility), AAPC or AHIMA
- High school diploma or equivalency required. Associates degree in business or accounting –related field preferred.
- Training or prior experience in CPT/ICD-10 coding desired.
- Excellent knowledge and understanding of ICD-10, CPT & HCPCS coding
- Efficient use of modifiers
- Strong understanding of the Correct Coding initiative
- Proficient in the understanding of the different types of government insurance companies billing guidelines