Medicare-Medicaid Billing Specialist Remote/Hybrid | Full Time Days | 8:30am-5pm ** Pay rate up to $69,622/year, based on experience ** United Methodist Communities is seeking a Medicare-Medicaid Billing Specialist. The Medicare/Medicaid Billing Specialist is responsible for the reviewing, scrubbing, submission, recordings, and collections of all insurance billing and payments for Medicare and Medicaid. This position could be fully remote or be hybrid. Requirements for a Medicare-Medicaid Billing Specialist: Bachelor's degree in business administration, accounting, finance, or a related field of study and/or equivalent work experience. A minimum of 3 to 5 years Medicare/Medicaid billing experience in a Skilled Nursing or Long-Term Care environment. Experience working with third party insurance companies. Experience tracking and posting cash. Knowledge of UB forms. Proven knowledge of ICD-10 & CPT coding, knowledge of PDPM, PT, OT, and ST coding, condition codes, occurrence codes, as well as occurrence span codes and dates and billing guidelines. Knowledge of CMS/Medicare billing regulations. Must possess extensive knowledge of third-party payer types, as well as laws, regulations, and guidelines that pertain to healthcare providers. Strong Microsoft Office skills a must and willingness to learn, experiment and work with new technologies. Responsibilities for a Medicare-Medicaid Billing Specialist: Monthly billing of Medicare A and B claims, PDPM, and Medicaid Skilled Nursing residents. Monthly billing to third party insurance companies. Prepare secondary insurance submissions where applicable. Preparing and reviewing all UB claims prior to electronic submission. Review all billing for coding accuracy. Generates and submits clean claims for all payer sources timely and accurately. Reconciling patient days of care between billing files and clinical reports. Manage Medicare Suspense files daily. Actively pursue past due claims by aggressively managing the A/R Aging. Communicate with Medicare/Medicaid, clinical and business office team to promote timely payments. Performs all denial management and collections procedures to obtain payments. Process HIPPS coding changes due to audits or clinical updates after claim processes. Review daily reports for errors and make appropriate corrections. Review posted payments and adjustments, research payment issue/discrepancies. Documents all activities and status in billing software. Communicate status with business office and mangers as directed. Review outstanding Accounts Receivables and create an action plan to receive payment. Identifies and escalates potential at-risk accounts, follows up with business office and direct supervision. About UMC: Our Mission is to serve our community with passion, so all are free to choose abundant life and thrive by embracing an active lifestyle Certified A Great Place to Work for the last 6 years, we continue to grow and innovate to meet the needs of our residents while building upon our rich history of over 115-years of dedication to the communities we serve We offer 4 Full-Service Communities, 5 Affordable Housing Communities and HomeWorks throughout the State of NJ, offering a variety of options from Independent Living, Assisted Living, Memory Care, Long Term Care, Short Term Rehab, home care and more! Our company culture at UMC is built on our values of Compassion, Respect, Stewardship and Service. Benefits offered by UMC for our Associates/Team Members: Employer-subsidized Medical and Dental Coverage (eligible at 30-hours per week)403(b) Retirement Savings Program with Employer Match Employee Assistance Program Tuition Assistance, Professional Development and E-Learning Employee Discount Program Homeowner/Renter/Automobile Insurance (NJ Manufacturers) Generous Paid Time Off Program Group Life Insurance (No Cost to YOU!)9 Paid Holidays/Premium Pay when working holidays Free uniform items & additional uniform allowances Additional great benefits like Vision coverage, Health Savings Account, Voluntary Life Insurance & so much more! UMC is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by laws and regulations.
