Insight Global
Insight Global is seeking a Medicare Billing Specialist to join their client’s team. The Medicare Billing Specialist is responsible for accurate preparation, submission, and reconciliation of Medicare claims for outpatient mental health services, ensuring compliance with Medicare regulations and supporting the clinic’s financial health.
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.
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.
Required Skills and 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.
Role Information
Location: Pleasanton, CA (Onsite) – Mon‑Fri, 8:30 AM start time
Pay: $24.00/hr – $26.00/hr
Hours: 40 hours per week, paid weekly
Benefits: Medical, dental, vision, HSA, 401(k), and more
Contract: 6‑month contract to permanent hire
Seniority level: Associate
Employment type: Full‑time
Job function: Accounting/Auditing within Health and Human Services
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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.
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.
Required Skills and 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.
Role Information
Location: Pleasanton, CA (Onsite) – Mon‑Fri, 8:30 AM start time
Pay: $24.00/hr – $26.00/hr
Hours: 40 hours per week, paid weekly
Benefits: Medical, dental, vision, HSA, 401(k), and more
Contract: 6‑month contract to permanent hire
Seniority level: Associate
Employment type: Full‑time
Job function: Accounting/Auditing within Health and Human Services
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