Must have Long Term Care/ Skilled Nursing Facility Medicare / HMO Billing Experience***Medicare / HMO BillerJob Summary:The Medicare / HMO Biller is responsible for managing and processing Medicare/ HMO billing for a nursing home facility in compliance with state and federal regulations. This role plays a critical part in ensuring accurate and timely reimbursement for services rendered to residents. The Biller works closely with the business office, healthcare providers, and government agencies to maintain efficient billing processes. Responsibilities: Medicare / HMO Billing:
Prepare and submit Medicare claims for reimbursement in accordance with state and federal guidelines.
Verify resident eligibility and ensure accurate documentation for timely Medicaid billing.
Monitor changes in Medicare regulations and adjust billing practices accordingly.
Post charges and payments to correct accounts
Communicate with insurance providers and therapists
Review patient bills and correct any missing or inaccurate information
Use billing software to prepare and transmit claims
Collect unpaid claims and clear up discrepancies by telephone, fax or email communication
Use of insurance carrier portals for eligibility and claims information
Investigate and appeal claims that were denied
Complete data entry to update spreadsheets and reports Documentation and Recordkeeping:
Maintain accurate and up-to-date resident records related to Medicare / HMO billing.
Ensure documentation supports Medicare / HMO billing and is in compliance with regulatory requirements.
Collaborate with healthcare providers to obtain necessary documentation. Claims Processing and Follow-Up:
Monitor the status of Medicaid claims, identify and resolve any issues or denials.
Conduct follow-up activities to ensure timely reimbursement.
Address inquiries from government agencies and other stakeholders related to Medicare / HMO billing. Financial Reporting:
Generate reports related to Medicare / HMO billing and reimbursement for internal and external use.
Provide regular updates to the Regional Business Office Manager on billing performance and issues.
Provide Monthly updates to Regional Business Office Manager, CEO and COO on amounts of claims filed. Training and Compliance:
Stay informed about changes in Medicare / HMO policies, procedures, and regulations.
Train relevant staff on proper Medicare / HMO billing practices and compliance requirements and complete monthly aging reviews with each facility BOM.
Collaborate with the Regional Business Office Manager to address compliance concerns. Customer Service:
Provide assistance and information to internal staff on Medicare / HMO billing matters.
