WHMG Billing- Medicare/Medicaid Professional Billing Specialist - FT - 1st Shift Job Listing at Wilson Health in Sidney, OH (Job ID 8a7885a89664876c01966e1aa3103ab7)

Description

Wilson Health is seeking a full-time, experienced Medicare/Medicaid Professional Billing Specialist for our location in Sidney, Ohio.   Key Perks and Benefits:

• Access to Employer Direct Care Clinic.  Free medical care and pharmacy services for all benefit eligible employees.  Dependents are eligible for free medical care if they are covered by Wilson Health's medical insurance plan.
• Generous paid time off program beginning day one of employment.
• Medical Insurance: Choice of Two High Deductible Health Plan Options or a PPO, Dental and Vision Insurance. Coverage begins the first day of the month after hire.
• H S A with employer contribution for eligible health plans, FSA for medical and dependent care expenses.
• Company Paid Life Insurance, Short-Term, and Long-Term Disability Insurance.
• Voluntary Accident, Critical Illness, and employee and dependent Life and AD&D Insurance.
• Industry leading retirement plan- employer contributions begin day one, no waiting period for participation.
• Tuition Assistance Program.

Employment Status: Full Time                   Position Reports To: Manager, Patient Accounting Working Hours: Monday – Friday, Flexible Working Hours, Begin as Early as 6:30 am. Option for either 8 or 9 hour work day.   Who We Are: At Wilson Health, our mission is to improve the health and wellness of our communities by delivering compassionate, quality care. We are committed to making a difference for our neighbors, friends, and family and our vision is to be a trusted, nationally recognized leader of innovative, collaborative community health.   POSITION SUMMARY: Under the direction of the Manager of Patient Accounts, the Medicare/Medicaid Professional Billing Specialist releases Medicare/Medicaid HMO and MSP (Medicare Secondary payer) claims electronically, and mails hard copy 1500 claims as required. The Medicare Billing Specialist will follow up on unpaid claims and rebill or Appeal claims as indicated. A Medicare/Medicaid Professional Billing Specialist works the PNM and CGS portals for rejections and pending claims.   KEY DUTIES AND RESPONSIBILITIES: Billing of Medicare/Medicaid Payer claims through Electronic Vendor (Quadax), which requires keeping up to date with Payer requirements and/or edits.   Submits claim electronically or a hard copy for MSP claims with appropriate information from the primary payer.   Bills secondary, tertiary, etc., claims electronically or mails the 1500 with EOB as required by the Payer.   Monitors claims using the Medicare and Medicaid portal.   Works closely with all physician groups and staff regarding charges and/or late charges.   Responsible for follow-up of all Medicare/Medicaid Professional Commercial Payers secondary to Medicare.   Works the 30-day and out worklist in the EMR/IHIS and contacts Payers via phone or Payer website regarding no pays or denials. Appeals claims on behalf of the patient to secure payment, or if a claim has been denied for inappropriate reasons.   Medicare/Medicaid Professional Billing Specialist also follows up on the Appeal.   Works mail as it applies to the Medicare/Medicaid Professional Billing Specialist to secure payment.   Works closely with physician groups and staff, and Medical Records regarding denials for no authorizations and/or medical necessity to secure appropriate documentation and/or diagnosis to submit a corrected claim or appeal.   Works Cash Report daily to ensure proper payment from Payers and makes appropriate adjustments as required.   Submits documentation to the Professional Supervisor or Manager of Patient Accounts for refunds.   Receives phone calls from patients regarding account balances, itemized bills, or Explanation of Benefits.   EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED) and a minimum of one year of experience and/or training; or equivalent combination of education and experience.   Experience with Epic preferred. Microsoft Office/Excel Experience preferred.   EOE

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