Government Claims Representative

Overview:Provide daily management of claims processing and submission of Government claims for homecare. Performs regular and consistent follow up, denial management, correction and/or reprocessing of claims as necessary. Excellent understanding of multiple products such as PMAPs and Medicare Advantage plans.Responsibilities:Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission including knowledge of the grievance and/or reconsideration processAbility to handle complex claim submission and follow upFor example: benefits exhausted, Part B only, AB rebills, Outlier claims, ConsolidatedFunding, and three day ruleGood understanding of benefit contracts, policies, government regulations, coordination of benefits, and healthcare terminologyManages quarterly Medicare credit balance report and resolves open credit balancesUtilizes all resources available, including electronic inquiries to verify eligibility, benefits, and claim statusResolves Return to Provider (RTP) claims using Direct Date Entry (DDE)Enters Hospice Notice of Election (NOE) claims via DDEExercises good judgement towards account resolution and documents all activity on account in clear, accurate, and consistent mannerResearches problem accounts and take necessary action and/or make recommendations to ensure timely resolution of account balances and resolve credit balance accountsContact patient for additional information in order to have claims processed and paid in a timely mannerPerform due diligence to contact patient by phone and/or send a letterAdvise manager/coordinator of any billing errors, payer trends, denials, or payment fluctuations, to ensure proper handling and escalation when necessaryMeet departmental productivity and quality assurance standards in accordance with departmental policiesMaintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standardsActively participates in creating and implementing improvementsPerforms other responsibilities as needed/assignedQualifications:High school graduate or equivalentMinimum 2 years office experienceExperience in a healthcare setting preferredKnowledge: Government billing requirementsCPT and ICD10 codingUB04 and CMS1500 claim formsAttention to Detail: Achieves thoroughness and accuracy when accomplishing a taskComputer Skills Basic: Ability to use a computer and applications that are associated with performing basic work tasks (navigate in Windows, Outlook, etc)Data Entry: Skilled in entering data and calculating items for processing; input of data into computer systemsMath Basic Skills: Knowledge and skills related to applying mathematical tools and methods for routine calculationsMedical Terminology/Spelling: Familiar with medical terminology and medical spellingOrganization: Effective management of projects, deadlines, and work load prioritizingPutting things together in an orderly and functional wholeProblem Solving: Identifies problemsDetermines accuracy and relevance of informationUtilizes appropriate tools and staff resources along with sound judgment to generate and evaluate alternatives, and to make recommendationsAbout HealthEastAt HealthEast, our patients are our neighbors and we are dedicated to their, and our, optimal health and well-being. We are guided by our faith-based heritage, a call to healing that respects the dignity and culture of every person. We empower our patients with user-friendly access to their health information, dependable service, and affordable, high-quality care.We put new, more efficient models of care into practice, allowing our 7,500 employees and 850 physicians to focus on what s important: providing compassionate health care that puts the patient and their needs first. With 14 clinics, home care, a medical transportation center, and four hospitals Bethesda Hospital, St. John s Hospital, St. Joseph s Hospital, and Woodwinds Health Campus we provide excellent family health and specialization, including primary, maternity, orthopaedics and post-acute care.