We are a privately owned revenue cycle management company providing comprehensive revenue cycle services to hospitals and other healthcare provider organizations. We are seeking a full-time, experienced Medicare A/R Representative to manage Medicare billing and follow-up for hospital claims on behalf of our hospital clients. This role is responsible for handling facility claims across Medicare Part A and Part B, including inpatient, outpatient, and observation services.
Key Responsibilities:
- Process, review, and submit Medicare claims (UB04) for hospital inpatient (Part A) and outpatient (Part B) services in compliance with CMS guidelines.
- Utilize Medicare Direct Data Entry (DDE) to check claim status, correct errors, RTP issues, and resubmit claims as needed.
- Analyze remittance advice (835/ERA/EOB) to identify underpayments, denials, and payment variances.
- Follow up on unpaid or incorrectly paid claims to ensure proper reimbursement.
- Identify denial trends and proactively address root causes in collaboration with internal teams.
- Stay current on Medicare regulations and requirements such as LCDs and NCCI edits.
- Maintain confidentiality and comply with HIPAA and organizational policies.
- Work within applicable systems to review accounts aiming for proper Medicare and other payer reimbursement.
- Ensure timely and accurate billing compliance with Medicare regulations.
- Conduct ongoing account follow-up to maximize reimbursement.
- Communicate effectively with internal teams, Medicare representatives, clients, and others.
- Collaborate with coding, registration, and clinical teams to correct billing discrepancies.
- Respond professionally and accurately to patient and payer billing inquiries.
- Assist in implementing process improvements to enhance billing efficiency and reduce errors.
Qualifications:
- Minimum of 3 years Medicare hospital billing and follow-up experience (inpatient and outpatient).
- Strong working knowledge of Fiscal Intermediary Standard System (FISS).
- 3+ years experience using Meditech.
- Strong knowledge of Medicare DDE and RTP processes.
- In-depth understanding of Medicare Part A and Part B billing requirements.
- Knowledge of CPT, ICD-10, and HCPCS coding concepts related to billing and reimbursement.
- California Medicare billing experience and additional payer knowledge are pluses.
- High attention to detail, strong organizational skills, and ability to work independently.
- Proficiency in Microsoft Office; knowledge of medical terminology.
Work Environment:
- Office-based position with potential for remote/hybrid work based on performance and needs.
Benefits:
- 401(k), dental, health, vision, life insurance
- Health savings account
- Paid time off
Minimum 3 years Medicare hospital billing and follow-up experience including inpatient and outpatient services. Strong knowledge of Medicare billing systems and regulations. Experience with FISS, Meditech, Medicare DDE and RTP. Understanding of CPT, ICD-10, HCPCS codes. Attention to detail and organizational skills. Ability to work independently in an office-based environment. Proficiency in Microsoft Office and medical terminology.
401(k) Dental insurance Health insurance Health savings account Life insurance Paid time off Vision insurance
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
3 weeks ago