• Job Description

  Req#: JR 2025-104931

  Primary Location:

  Med Plaza II - UMC

  Address:

  250 E Liberty Louisville, KY 40202

  Shift:

  First Shift (United States of America)

  Job Description Summary:

  Job Description:

  This position requires thorough knowledge of the Uniform Bill, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicare eligibility, benefits, determining primary payer, and covered benefits.

  Additional Job Description:

  • Monitor and resolve claims holding on discharged not final billed (DNFB) list.
  • Assure all claims are filed electronically except for some paper claims.
  • Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.
  • Follow up on unpaid Medicare and Medicare Advantage claims in a timely manner.
  • High dollar accounts will have consistent follow up until the account has been resolved.
  • Responsible for reviewing and understanding explanation of benefits/remittance advice.
  • Assure statements are generated for the patient responsibility amounts.
  • Utilize insurance websites to view and resolve claims.
  • Perform extensive account follow-up and provide analysis of problem accounts.
  • Document all follow up efforts in a clear and concise manner into the AR system.
  • Submit shadow claims to Medicare for inpatient Medicare Advantage payers.
  • Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials
  • Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account
  • Adhere to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers.
  • Assure medical record requests are documented and submitted in a timely manner
  • Submit RAC correspondence to appropriate Denials/Appeals Specialist.
  • Identify and report all trends that may provide insight into payment challenges.
  • Phone contact with patient, physician office, attorney, etc for additional information to process claims.
  • Work assigned accounts as directed while reaching daily productivity goals.
  • Complete tasks by deadline.
  • Attend seminars as requested.
  • Other duties as assigned.

• About the company

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