What You'll Do
The Medicare Part A Biller is responsible for the accurate and timely billing of Medicare Part A claims, ensuring compliance with federal regulations, payer requirements, and organizational policies. This position reviews patient accounts, verifies coverage, prepares and submits claims, resolves billing issues, follows up on unpaid accounts, and works closely with clinical and administrative staff to maximize reimbursement and maintain compliance.
Key responsibilities include:
- Prepare and submit Medicare Part A claims accurately and within required deadlines
- Verify resident eligibility, insurance coverage, authorization requirements and benefits
- Ensure billing compliance with Medicare guidelines, CMS regulations, and payer-specific requirements
- Review MDS and PDPM data to support billing accuracy
- Identify, research, and resolve claim rejections, denials, and payment discrepancies
- Process admissions, discharges, payer changes, and leave of absence billing
- Monitor Medicare accounts receivable and follow up on outstanding claims
- Collaborate with admissions, nursing, therapy, MDS, and business office teams
- Reconcile payments, remittances, and account balances.
- Assist with audits, appeals, and additional documentation requests
What We're Looking For
- Minimum of 3 years of Medicare Part A billing experience, preferably in a Skilled Nursing Facility.
- Strong knowledge of Medicare regulations, UB-04 billing, and reimbursement processes.
- Understanding of PDPM and MDS-related reimbursement requirements.
- Experience with PointClickCare, MatrixCare, AHT, or other long-term care software is a plus.
- Strong attention to detail and problem-solving skills.
- Excellent communication and organizational abilities.
- Proficiency in Microsoft Office, especially Excel.
Key Competencies
- Knowledge of Medicare Part A billing regulations
- Claims processing and accounts receivable management
- Denial resolution and appeals management
- Compliance and audit readiness
- Data analysis and reconciliation
- Time management and organization
- Customer service and communication
- Problem-solving and critical thinking
