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Robert Half Medicare Billing Specialist in Alhambra, California


A Healthcare Organization in Los Angeles is in immediate need of a Medicare Billing Specialist. The Medicare Billing Specialist will be responsible for the following duties:

• Complete filing and billing of daily charge entry and submission of claims to health plans and IPAs, either electronically or by hard copy billing (secondary/crossover billing), securing medical documentation required by third party insurance as required.

• Ensure that all conditions for claim submission have been satisfied, including but not limited to: accurate charges and financial class; authorization/certification information; demographic and insurance information; ICD-10 and CPT-4 coding; patient insurance eligibility and benefit coverage.

• Submit all claims to clearinghouse on a timely basis. Compile and generate reports as directed.

• Have a firm understanding changes in contracts, billing requirements and insurance types within area of responsibility; maintain knowledge of publicly funded programs, grants and third party insurance contracts including My Health LA, Medicare, Medi-Cal, managed care plans.

• Achieve and maintain days in A/R at best in class standards

• Address denials and resubmit claims as appropriate

• Submit all levels of appeals

• Follow-up with insurance carriers on unpaid claims until paid by correcting billing errors and resubmitting claims, contacting patients, contacting insurance plans, determining if a claim is a hardship case and what classification code or description should be assigned.

• Submit and follow-up on patient monthly statements; research patient inquiries.

• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.


Medicare , Medical Billing, UB04, DDE

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