Job Description

We are seeking an experienced Billing Claims Analyst with extensive knowledge of UB-04 billing and Medicare regulations. This role is responsible for accurate claim submission, follow-up, and resolution of Medicare hospital billing issues to ensure timely reimbursement and compliance with CMS guidelines.

Pre-Employment Requirements:

• We are a drug free facility. Passing a pre-employment drug screening is required

Education Requirements

• Must have a High School Diploma or GED.
• Coding certificate preferred.

Job Requirements:

• 5 - 10 years of hospital experience in 1500 and UB04 Billing, preferably Medicare.
• Recent working knowledge in Medicare Direct Data Entry (DDE) System.
• Proficiency navigating the WPS Medicare website, including ADRs, medical record uploads, appeals, and claim review
• In-depth knowledge of CMS Local Coverage Determinations (LCDs) related to hospital tests and procedures
• Experience calculating Medicare days (co-days, lifetime reserve days)
• Experience with Medicare edits, 72-hour overlap claims, clinical trials, and Hospice billing
• Ability to analyze, resolve, and appeal claim rejections and denials from Medicare, other payers, and clearinghouse