Insight Global

Compensation

Full Description

Medicare Billing Specialist Pay: $25-$28/hr Onsite Required Skills & Experience • High school diploma or equivalent; Associate or Bachelor’s degree in business or healthcare administration preferred. • 2+ years of experience specifically in Medicare billing. • Knowledge of CMS 1500 claims, CPT/HCPCS coding, ICD-10, and Medicare fee schedules. • Familiarity with EHR/billing platforms (Valant preferred, Epic otherwise) and clearinghouse systems. • Detail-oriented with strong analytical, communication, and problem-solving skills. • HIPAA compliance knowledge and ability to manage sensitive information. Job Description Insight Global is seeking a Medicare Billing Specialist to join their clients team. The Medicare Billing Specialist is responsible for the accurate preparation, submission, and reconciliation of Medicare claims for outpatient mental health services. This role ensures compliance with Medicare regulations and supports the clinic’s financial health through timely claims processing, payment posting, denial management, and collaboration with providers to maintain accurate documentation. Key Responsibilities: • Prepare, review, and submit Medicare claims (CMS-1500) for outpatient mental health services. • Apply correct CPT, HCPCS, and ICD-10 codes in compliance with Medicare rules. • Ensure documentation meets “medical necessity” requirements. • Track claim submission deadlines to meet Medicare’s timely filing requirements. • Post Medicare remittances (EOBs/ERAs) to patient accounts. • Reconcile accounts and resolve payment discrepancies. • Identify underpayments and coordinate appeals or resubmissions. • Maintain current knowledge of CMS and Medicare guidelines for outpatient mental health. • Ensure provider documentation supports all billed services. • Audit claims to minimize risk of denials or audits. • Investigate and resolve denied or rejected claims. • Prepare appeals with supporting documentation as needed. • Track denial trends and recommend process improvements. • Provide monthly Medicare billing and collection reports to management. • Coordinate with front desk, eligibility staff, and clinical providers to ensure accurate patient insurance data. • Educate staff on Medicare requirements as needed. • Assist with other billing department functions as required.