Thorek Memorial Hospital is a stable community hospital with its roots in Chicago for almost 100 years. We are committed to excellence in patient care, serving our community, and committed to the continued learning of our employees.
We are seeking a Full-time Hospital Medicare & Medicaid Biller to join our team at Thorek Memorial Hospital.
Job Summary: The Medicare & Medicaid Hospital Biller is responsible for accurate and timely submission of claims to Medicare and Medicaid for hospital services rendered. This role requires in-depth knowledge of Medicare and Medicaid billing regulations, coding guidelines (ICD-10, CPT, HCPCS), and compliance standards to ensure maximum reimbursement while adhering to all federal and state guidelines. The ideal candidate will be highly detail-oriented, possess strong analytical skills, and have a proven track record in resolving complex billing issues.
Key Responsibilities:
- Prepares, reviews, and submits electronic and paper claims to Medicare and Medicaid for all hospital services (inpatient, outpatient, ancillary, etc.).
- Verifies patient eligibility and benefits for Medicare and Medicaid programs.
- Reviews medical documentation to ensure accurate coding (ICD-10, CPT, HCPCS) and proper claim submission.
- Identifies and resolves billing discrepancies, denials, and rejections related to Medicare and Medicaid claims.
- Submits corrected claims and appeals in a timely manner.
- Follows up on outstanding accounts receivable for Medicare and Medicaid to ensure prompt payment.
- Communicates effectively with internal departments (e.g., Coding, HIM, Patient Access) to resolve billing issues.
- Stays current with all Medicare and Medicaid billing regulations, policies, and updates.
- Maintains strict confidentiality of patient information.
- Assists with audits and compliance reviews as needed.
- Performs other duties as assigned to support the revenue cycle process.
- Has working knowledge of Illinois Medicaid secondary billing rules and regulations
- Has working knowledge of Medicare Part B 121 claims.
Qualifications:
- Education: High school diploma or equivalent required. Associate's or Bachelor's degree in healthcare administration, business, or a related field preferred.
- Experience: Minimum of 3-5 years of direct experience in hospital billing with a strong focus on Medicare and Medicaid.
- Knowledge:
- Comprehensive understanding of Medicare Part A and Part B billing regulations and guidelines.
- Comprehensive understanding of state-specific Medicaid billing regulations and guidelines.
- Proficiency in ICD-10, CPT, and HCPCS coding.
- Familiarity with medical terminology and anatomy.
- Knowledge of HIPAA and other healthcare compliance regulations.
- Experience with electronic health record (EHR) systems and billing software (e.g., Epic, Cerner, Meditech, Florida Share, Medicare CWF).
- Skills:
- Excellent analytical and problem-solving skills.
- Strong attention to detail and accuracy.
- Ability to work independently and as part of a team.
- Effective verbal and written communication skills.
- Proficient in Microsoft Office Suite (Word, Excel, Outlook).
- Strong organizational and time management skills.
Preferred Certifications (a plus but not required):
- Certified Professional Coder (CPC)
- Certified Professional Biller (CPB)
- Certified Revenue Cycle Specialist (CRCS)
Physical Demands: This is primarily a sedentary role; however, some filing and scanning may be required. This would require the ability to lift files, open filing cabinets, and bend or stand on a stool as necessary.
Work Environment: Typically performed in an office setting. May involve prolonged periods of sitting and computer use.
Thorek is an Equal Opportunity Employer
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
