Job Description

Position Summary

The HMO/Medicare Part A Billing Specialist is responsible for accurate and timely billing and collection of HMO and Medicare Part A claims for long term care and rehabilitation services. This role requires a strong understanding of health insurance, HMO, Medicare regulations, coding guidelines, and billing procedures.

Essential Duties and Responsibilities

1. Review and analyze patient medical records to ensure accurate coding and documentation for HMO and Medicare Part A claims.
2. Prepare and submit clean claims to Medicare, including inpatient and outpatient hospital services, skilled nursing facility stays, and home health services.
3. Research and resolve denied or rejected claims by working with Medicare and other payers.
4. Monitor claim status and ensure timely payment of claims.
5. Be aggressive in cash collections
6. Identify and correct errors in claims submission.
7. Maintain accurate records of all billing and collection activities.
8. Stay current on all Medicare regulations, coding guidelines, and billing procedures.
9. Assist with audits and other compliance activities.
10. Participate in team meetings and contribute to process improvement initiatives.
11. Other duties as assigned.

Qualifications

1. High School Diploma or equivalent required; Associate's Degree in Finance, Healthcare Administration or related field preferred.
2. Minimum of 2 years of experience in HMO, Medicare Part A billing and collections.
3. Strong understanding of Medicare regulations, coding guidelines (ICD-10, CPT, HCPCS), and billing procedures.
4. Experience with electronic data interchange (EDI) and claims submission software. Matrix preferred
5. Excellent analytical and problem-solving skills.
6. Strong attention to detail and accuracy.
7. Excellent communication and interpersonal skills.
8. Ability to work independently and as part of a team. 
9. 3 years of cash collections experience
10. Proficient in Microsoft Office Suite. 

Benefits

NHS Management offers a competitive salary and benefits package, including:

1. Medical, dental, and vision insurance
2. Life insurance and disability insurance
3. 401(k) retirement plan
4. Paid time off
5. Continuing education opportunities

Equal Opportunity Employer

NHS Management is an equal opportunity employer and values diversity. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Job Tags

Similar Jobs