Job Details

Medicare Billing Specialist

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

• Associate Degree in Accounting, Health Information Management, or related field preferred
• 1-2 years of experience in Medicare billing, medical claims processing, or hospital revenue cycle operations required
• Experience with charge entry, Medicare bad debt, and claims editing systems preferred

Knowledge, Skills and Abilities

• Proficiency in billing systems and electronic health records (EHR).
• Knowledge of Medicare regulations and claim processing requirements.
• Strong organizational and analytical skills with attention to detail.
• Ability to communicate effectively with internal teams and external payers.
• Ability to manage multiple tasks and deadlines in a high-volume setting.
• Familiarity with audit documentation standards and billing compliance.