Medicare Biller


Title: Medicare Biller
Req #: 570651
Location: 500 Superior Avenue, Suite 250, Newport Beach CA 92663
Duration: 6 Months
Hours: Monday through Friday 8:00 AM – 4:30 PM

·         Minimum 1-2 years of Hospital Experience, Experience with traditional Medicare (not Medicare HMO, Must know how to review and work in DDE, and RTP

Additional notes from Manager:
·         Must have inpatient and outpatient hospital billing

·         The Medicare Biller and Follow up Representative is responsible for the management of patient accounts from the point of admission to reimbursement from the payor.
·         Works directly with patients, internal departments, external business partners (IPA’s, provider relations, government payors and insurance companies) and clinical departments for delivery of service to include but not limited to:
·         Obtains the maximum reimbursement for hospital services, effectively maintains a professional and ethical relationship with all clients, payors and staff.
·         Has expert knowledge of payor contracts, CPT/HCPCS and ICD-10 codes, medical policies, LCD’s and medical terminology.
·         Works efficiently to ensure accounts are worked thoroughly and within a timely manner.
·         Thrives within a team atmosphere, has strong customer service expertise, has a strong ability to multitask and has proficient computer skills.

·         Serve as the account representative for Hoag in working with insurance companies and/or government payors for resolution of payments.
·         Completes daily assigned accounts on the collection work-list.
·         Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
·         Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
·         Conducts an audit of accounts for billing and regulatory requirements.
·         Help identifies charge capture and missing charge.
·         Recommends denial edits to help mitigate denials issues.
·         Reviews and completes payor correspondence in a timely manner.
·         Escalates to the payor accounts that need to be appealed due to improper billing, coding and/or underpayments. • Reports new/unknown billing edits to direct supervisor for review and resolution.
·         Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
·         Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
·         Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to insure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
·         Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
·         Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-cal)and how these payors process claims.
·         Demonstrates knowledge of and effectively uses patient accounting systems.
·         Performs other duties as assigned.


·         High school diploma or equivalent with 2-3 years of hospital billing and/or collection experience

Skills or Other Qualifications:
·         Analytical, critical thinking and sound decision making skills.
·         Basic skills in Microsoft Office (Word/Excel). Ability to communicate in a clear and professional manner.
·         Strong interpersonal skills.
·         Ability to problem solve, prioritize and follow-through completely with assigned tasks.

Thanks and Regards,

Swapnil Sawant

APN Software Services, Inc (

39899 Balentine Drive, Suite 385, Newark, CA 94560

Phone: 510-402-1080 / Fax 510-623-5055 

Email Id:

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