Medicare and Medicaid Billing Specialist

Medicare and Medicaid Billing Specialist

Owings Mills, MD

SINAI HOSPITAL

Full-time - Day shift - 8:00am-4:30pm

CLERICAL ADMIN

$18.17-$33.17 Experience based

Summary

Who We Are: LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to "improve the health of people in the communities we serve." Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.

About the Role: Under the supervision of the Supervisor and Manager of Patient Financial Services, the Billing Specialist is responsible for the accurate, complete, and prompt claim submission and resolution as assigned. The position validates, edits, corrects, and performs subsequent activity to obtain reimbursement according to state and federal requirements. Ensures activity is appropriately and thoroughly documented in systems. Meets productivity and quality expectations and performance goals for assigned accounts receivable inventory.

Key Responsibilities:

• Completes timely claim submission, denial management, payment variance, and accounts receivable resolution.
• Imports, edits, corrects and transmits hospital claims on a daily basis.
• Ensures activity is fully documented related to claim submission, follow-up and resolution in hospital systems.
• Investigates and/or refers to management systemic billing issues that cause delays in reimbursement.
• Identifies administrative denials by working denial work-items and through remittances; follows through with appeal or corrective action to obtain claim payment.
• Applies payor acceptance reports and 277 reports to manage payor rejections and take appropriate action for resolution.
• Applies appropriate HOLDS and subsequently releases claims based on billing requirements, coding needs and data deficiency.
• Reports HELD claims to management.
• Manages 72-hour billing compliance and provides reports as directed.
• Provides billing documentation (UB, IB) as requested.
• Confirm claim receipt, remittance, or additional information required for claim resolution within established timing thresholds.
• Prepares daily claims submission tracking and pending authorization reports.
• Reviews and identifies potential front-end errors to avoid payor delays and provides necessary feedback to points of registration and management.
• Monitors, researches and communicates front-end CMS Medical Necessity denials.
• Assists with implementing billing system upgrades.
• Works with internal and external customers to implement billing system upgrades.
• Maintains/identifies Payor ID Alias(s) to maximize and expedite electronic billing processes
• Coordinates with departments to confirm correct and timely coding information.
• Coordinates within department and outside department to resolve issues related to billing/claim submission.
• Collaborates with Patient Access, Patient Financial Services/Clearance, HIM, Case Management, IT, and any other relevant departments to determine revisions needed for registration quality, charge corrections, claim submission, and accurate reporting

Requirements:

• Education: HS Diploma/GED preferred
• Experience: 2 to 4 years of medicare claims, follow up and billing experience, Training is on site for minimum of 90 days so candidates must be local.

Key Words

Governmental Billing

Medicare

Medicaid

Claims Processor

Billing Specialist

Facility billing

Additional Information

What We Offer: Impact: Join a team that values innovation and outcomes, delivering life-saving care to our youngest and most vulnerable patients. Growth : Opportunities for professional development, including tuition reimbursement and developing foundational skills for neonatal critical care leadership and advanced certification. Support: A culture of collaboration with resources like unit-based practice councils and advanced clinical education support improving both workflow efficiency and patient outcomes and allowing you to work at the top of your license. Benefits : Competitive compensation (additional compensation such as overtime, shift differentials, premium pay, and bonuses may apply depending on job), comprehensive health plans, free parking, and wellness programs.

Why LifeBridge Health? With over 14,000 employees, 130 care locations, and two million annual patient encounters, we combine strategic growth, innovation, and deep community commitment to deliver exceptional care anchored by five leading centers in the Baltimore region: Sinai Hospital of Baltimore, Grace Medical Center, Northwest Hospital, Carroll Hospital, and Levindale Hebrew Geriatric Center and Hospital. Our organization thrives on a culture of CARE BRAVELYwhere compassion, courage, and urgency drive every decision, empowering teams to shape the future of healthcare. LifeBridge Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression.