Medical Biller

Description:

Responsibilities:

• Prepare, review, and submit accurate insurance claims for hospital and nursing home services, including inpatient, outpatient, and skilled nursing facility (SNF) billing.
• Perform accurate charge entry and payment posting for hospital departments and nursing home patient accounts.
• Monitor accounts receivable and follow up on unpaid claims, denials, rejections, and appeals with Medicare, Medicaid, and commercial payers.
• Apply appropriate billing and coding standards, including CPT, ICD-10, HCPCS in compliance with hospital and nursing home guidelines.
• Reconcile insurance payments, patient responsibility balances, adjustments, and contractual allowances to ensure financial accuracy.
• Maintain complete, organized, and compliant billing documentation, including medical necessity, authorizations, and supporting clinical records.
• Collaborate with hospital departments, nursing staff, case management teams, and providers to resolve billing discrepancies and improve revenue cycle processes.
• Ensure compliance with payer-specific billing rules for hospital and nursing home services, including Medicare Part A & B, Medicaid, and managed care plans.
• Generate and analyze financial reports such as aging reports, denial trends, and collection performance summaries.
• Stay updated on CMS regulations, insurance policies, and healthcare billing compliance requirements related to hospital and long-term care services.

Requirements:

• Minimum Bachelor’s degree.
• Minimum of 3 years of experience in hospital and/or nursing home medical billing.
• Proficiency in medical billing software and electronic health record (EHR) systems.
• Strong knowledge of CPT, ICD-10, HCPCS, UB-04, and CMS-1500 billing forms.
• Strong communication and interpersonal skills for interacting with patients, providers, and insurance representatives.