Government Billing Specialist MediCare and MediCal

Job Description

Job Description

Responsible for the accurate and timely billing, follow up, and collections of claims to government intermediaries and /or secondary payors. The position monitors and performs a variety of duties and responsibilities related to billing and collection for timely and accurate claim submission, resolution on non-payment of accounts, denials, addressing billing questions, reviewing patient accounts, and follow up. The Government Billing Specialist is expected to maintain the aging less than 120 days, maximize cash flow, be familiar with current regulatory requirements, electronic and hard copy billing, and UB04 billing formats.

QUALIFICATIONS:

• 2 years of recent Medi-Cal and Medi-Care Billing experience - Acute Care Hospital

• Knowledge of medical terminology

• Understand UB04 claim form, CPT, HCPCS, ICD-9, and ICD-10 Codes

• Proficient with Microsoft Word and Excel computer applications

• High school diploma.

JOB RESPONSIBILITIES:

• Daily billing of all claims ready for billing.

• Posts daily adjustments to accounts daily as approved by Business Office Manager

• Gathers and updates information and financial files in hospital system daily.

• Review all denial and errors and make corrections as needed on a timely basis.

• Review all outpatient Medi-Care and Medi-Cal claims for complete and accurate CPT coding for appropriate reimbursement.

• Bills all Medi-Care and Medi-Cal crossover claims on a daily basis.

• Reviews Medi-Care and Medi-Cal remittances on a daily basis to ensure that the correct payments were made.

• Reviews claims before billing for complete charges and coding

• Analyzes and reviews receivables for various refund and invoice processing.

• Ensures inpatient claims have appropriate TAR based on Medi-Cal and Medi-Care requirements

• Proactively follows up until claim is resolved

• Reviews insurance EOBs/ERAs to verify proper adjudication and payment of claims

• Responds to insurance correspondence and improper denials of claims

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for CMC roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that CMC in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

EEO Statement

All College Medical Center subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. College Medical Center subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.  

Notice

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At College Medical Center and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at College Medical Center and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. Email correspondence will come from the domains @collegemedicalcenter.com or @glendorahospital.com.

If you suspect a fraudulent job posting or job-related email mentioning College Medical Center or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate College Medical Center  subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.