Billing - Subject Matter Expert

As a Billing - Subject Matter Expert at Medtronic, you'll be responsible for ensuring the accuracy, completeness, and compliance of all charge capture and billing processes. Your expertise will be crucial in identifying and correcting errors, managing denied claims, and staying updated on complex payer regulations to optimize the revenue cycle and support Medtronic's mission in healthcare.

A Day in the Life

You will drive efficiency and accuracy in billing operations by:

• Reviewing and analyzing charge capture data for accuracy and completeness.
• Identifying and correcting charge errors and discrepancies.
• Collaborating with clinical and coding staff to resolve charge-related issues.
• Monitoring and reviewing billing processes to ensure compliance with payer guidelines.
• Identifying billing errors and making necessary corrections to avoid claim denials.
• Ensuring timely and accurate submission of claims to payers.
• Managing the resolution of denied claims by identifying root causes and correcting errors.
• Resubmitting corrected claims to payers for reimbursement.
• Tracking and reporting on claim correction activities and outcomes.
• Ensuring all billing and charge correction activities comply with relevant laws, regulations, and internal policies.
• Staying updated on changes in billing regulations and payer requirements.
• Leveraging your experience with various insurance plans (PPO, HMO, EPO, POS, Medicare, Medicaid, HRAs) and coordination of healthcare benefits, including referral, authorization, and pre-determination requirements.

Required Knowledge and Experience

• Bachelor's degree in business or accounting is preferred.
• 6 years of experience in healthcare insurance collections, accounts receivable management, billing and claims processing, and insurance payer contracts.
• Advanced knowledge of insurance contracting, payer regulations, insurance benefits, coordination of benefits, managed care, and healthcare compliance, rules, and regulations.
• Advanced experience with reading and understanding medical policy information, and utilizing insurance benefit and coverage information to recover denied claims.
• Advanced experience with various insurance plans offered by both government and commercial insurances.
• Experience with medical billing and collections terminology - CPT, HCPCS, ICD-10 and NDC coding, HIPAA guidelines, and healthcare compliance.