Hospital Billing Specialist Medicare

United Surgical Partners International Inc (USPI); Dallas (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

United Surgical Partners International Inc (USPI) seeks a Hospital Billing Specialist, Medicare, in Dallas to ensure timely and accurate Medicare claim submissions for acute care surgical hospital services.

Reporting to the Billing Manager, you will utilize DDE, Ability Ease, and Novitasphere among other systems to ensure clean claims, resolve denials, and support period-end close. A strong Medicare background and communication skills are essential.

Qualifications

• 3-4 years hospital billing experience with emphasis on Medicare billing.
• Experience with electronic patient information systems.
• Function as a subject matter expert (SME) for Medicare.
• Experience with Ability, DDE, nThrive, Cerner, etc. required.
• Preference shown to previous facility setting experience.

Responsibilities

• Extract and verify information from medical records, invoices and discharge paperwork for accurate charge entry.
• Capture implants, high-cost supplies, drugs, and other items prior to charge submission.
• Review invoice details for accuracy including pricing and state taxes.
• Submit claims daily and manage the claims clearinghouse.
• Resolve claim denials and resubmit correctly to payers.
• Reconcile revenue during period-end close and maintain documentation.

Skills

Independent work

Time management

Critical thinking

Communication skills

Interpersonal skills

Attention to detail

Tools

DDE

Ability Ease

Novitasphere

Cerner

nThrive

Microsoft Office

Job description

Position Overview

We are looking for a motivated performer to join the Centralized Training Office as a Hospital Billing Specialist focused on Medicare. We are looking for a top performer with extensive knowledge of billing processes. Reporting to the Billing Manager, the Hospital Billing Specialist, Medicare is responsible for the timely and accurate submission of claims ensuring those claims result in maximum reimbursement. This will encompass services rendered in an Acute Care Surgical Hospital setting.

Responsibilities

Pull any preoperative notes from the designated transcription company.

• Extract information from medical records, operative notes, invoices, progress notes and discharge paperwork to ensure completeness and accuracy of charge entry.
• Capture implants, high-cost supplies, high-cost drugs, post op pain blocks and observations times prior to charge submission
• Review accuracy of invoice details, including customer billing instructions, pricing, discounts, state sales tax, etc.
• Execute the recurring billing workflow and generate and transmit claims daily.
• Ensure timely follow-up and resolution of internal and external inquiries of billing issues (i.e., operative notes, POPM form, invoices, or implant pricing etc).
• Reconcile revenue and billing during the period-end close process.
• Complete accurate charge entry for all assigned cases and upload to designated electronic claims clearinghouse daily.
• Resolve claim rejections daily to ensure clean claims are transmitted and received by the appropriate payer.
• Investigate, appeal, and resolve denied or unpaid claims, ensuring correct resubmission and payment.
• Navigate the DDE and make the appropriate claims corrections when appropriate.
• Manage claim resubmission queues in a timely manner.
• Maintain current knowledge of health care billing laws, rules, regulations, and developments.
• Complete Special Projects when appropriate.
• Complete other duties as assigned.

Required Skills

Requirements

• Experience in DDE system, Ability Ease, and Novitasphere
• 3-4 years previous Hospital billing experience, with emphasis on Medicare billing
• Preference shown to previous experience in a Facility setting
• Ability to work independently
• Excellent communication skills and interpersonal skills
• Skilled in time management and prioritization of emergent situations
• Comfortable utilizing critical thinking skills
• Proficient with Microsoft Office products
• Experience with electronic patient information systems
• Function as a subject matter expert (SME) for Medicare
• Experience with Ability, DDE, nThrive, Cerner, etc required.

Required Experience

Qualifications

Requirements

• Experience in DDE system, Ability Ease, and Novitasphere
• 3-4 years previous Hospital billing experience, with emphasis on Medicare billing
• Preference shown to previous experience in a Facility setting
• Ability to work independently
• Excellent communication skills and interpersonal skills
• Skilled in time management and prioritization of emergent situations
• Comfortable utilizing critical thinking skills
• Proficient with Microsoft Office products
• Experience with electronic patient information systems
• Function as a subject matter expert (SME) for Medicare
• Experience with Ability, DDE, nThrive, Cerner, etc required.