Description Revenue Cycle Specialist (Medicare) – Nashville, TN / Remote – Full Time, Monday – Friday, 40 hours per week Summary Primarily responsible for generating billing cycles, posting payments, and following up on claims to ensure timely payment. Essential Duties and Responsibilities Generates patient claims through EMR billing system. Upload EMC file to clearinghouse as soon after target bill date as possible and errors/holds are cleared. Continue review of unsubmitted claims to avoid timely filing errors. Manage and hold claims waiting compliance review completion. Work with Revenue Cycle team to ensure billing compliance. Review, key, or follow up on 81A (NOE) prior to submission of initial claim. (if applicable to assigned duties) Review, key, or follow up on 815's, 817's and 818's when necessary. Review and correct RTP's in the DDE system on a regular basis. Post Medicare PIP remittance advices through Clearinghouse auto‑post or manually when necessary. Follow up regularly on unpaid claims by using DDE or phone call to PBGA service center for assistance or unresolved claim issues. Document response and any follow‑up actions taken in EMR. Work with the Dept. Director on Medicare credit balances to ensure compliance. Work with other hospice agencies to ensure smooth transitions between benefit periods and sequential billing. Notify the Dept. Director of any problems with claims or processes. Assist other Revenue Cycle Specialists as needed to meet department goals. Submit write‑off requests with documentation after all collection efforts have been exhausted to the Dept. Director. Run admission report, assign and enter appropriate ICD‑10 codes into EMR based on physician CTI. (if applicable to assigned duties) Using pre‑bill CPT audit sample to complete compliance review through physician coding compliance software. Report findings to appropriate Directors and CMO. (if applicable to assigned duties) Report individual findings to the physician for review and resolution of the coding discrepancy. After physician review/approval, make coding changes and note in EMR. Report to billing staff when claim can be released. (if applicable to assigned duties) Other duties may also be assigned. Requirements Education and/or Experience High school diploma required. One year college or technical school: one to three years of related experience or equivalent combination of education and experience. Certificates, Licenses, Registrations If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law. #J-18808-Ljbffr
Revenue Cycle Specialist - Medicare • Nashville, TN, United States
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