Hospital Medicare Representative

Hospital Medicare Representative

Reviews outstanding accounts for assigned payer and takes appropriate action to resolve issues preventing or delaying payment, including appealing denials. Works closely with the Electronic Billing Coordinator to assure initial claims are submitted correctly. Responds to inquiries and requests from various sources related to hospital claims and account processing.

Requirements :

• Fully knowledgeable of, and conducts all activities in accordance with Medicare regulatory compliance requirements, including but not limited to billing regulations, Medicare Secondary Payer Screening requirements, medical necessity screening and ABN rules, Red Flag Rules, and billing and coding compliance rules and regulations.
• Knowledge and understanding of AHS managed care payer and Medicare supplement rules.
• Previous hospital billing experience required. Experience billing hospital claims to Medicare strongly preferred.
• Experience investigating Correct Coding Initiative edits required.
• Knowledge of Medicare specific billing rules and regulations required.
• High school graduate or equivalent required.

Preferred Qualifications :

Why Join the Avita Health System Team?

At Avita, we're committed to creating a supportive, inclusive, and empowering environment where every team member plays a vital role in delivering exceptional care to our communities. Whether you're on the front lines or behind the scenes, your work matters here.

What You Can Expect at Avita :

Join a team that values your contributions and supports your career journey every step of the way.

Job ID : #10528

Location : Crestline Office Building - Patient Financial Services Department

Avita Health System is an Equal Opportunity Employer .

Monday-Friday 8 : 00a - 4 : 30p