Medicare Billing Specialist- Onsite

Job Summary

The Medicare Billing Specialist is responsible for performing timely and accurate Medicare billing activities, including claims preparation, eligibility verification, census validation, and documentation review. This role collaborates with revenue cycle teams, clinical departments, and external payers to ensure claims are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state billing regulations and assists in resolving claim discrepancies to reduce denials and ensure proper reimbursement.

Essential Functions

• Prepares and submits Medicare claims in accordance with billing guidelines and payer requirements.
• Validates patient coverage and benefits using tools such as Common Working File (CWF), payer portals, and internal systems.
• Coordinates with admissions and clinical teams to ensure complete documentation and accurate financial account setup.
• Tracks and monitors census data to identify discrepancies and resolve issues impacting billing.
• Supports the month-end billing process, including clearing system edits, resolving errors, and participating in claim reviews.
• Monitors co-pay responsibilities and coordinates with financial counselors for communication and collection when applicable.
• Ensures documentation and billing practices align with audit and compliance expectations.
• Escalates unresolved billing issues or delays to appropriate leadership.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

Knowledge, Skills and Abilities

Seniority level

Employment type

Job function

Industries

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