SNF Medicare Billing Specialist

Position Overview

PMTAC is seeking an experienced SNF Medicare Billing Specialist with strong knowledge of the Patient-Driven Payment Model (PDPM) and Skilled Nursing Facility (SNF) Medicare Part A billing requirements. The ideal candidate will have hands-on experience with MDS-driven reimbursement, HIPPS coding, and UB-04 claim submission.

This role requires a strong understanding of Centers for Medicare & Medicaid Services (CMS) billing guidelines and compliance regulations.

Key Responsibilities

• Medicare Eligibility Verification
• Verify Medicare Part A coverage for SNF residents.
• Confirm qualifying 3-day hospital stay and benefit period.
• Review secondary insurance coverage (Medicaid, Medicare Advantage, commercial payers).
• MDS & PDPM Coordination
• Review and ensure accurate completion of Minimum Data Set (MDS) assessments.
• Validate:
• Clinical conditions
• Functional status
• Comorbidities
• Confirm HIPPS code generation from MDS.
• Ensure documentation supports PDPM classification.
• Understand and apply the guidelines of the Patient-Driven Payment Model.
• UB-04 (CMS-1450) Claim Preparation
• Prepare and submit facility claims using the UB-04 (CMS-1450) form.
• Accurately complete required fields including:
• Type of Bill (21X)
• Statement Covers Period
• Revenue Codes (0022–0029 for PDPM)
• HIPPS Code
• Units (covered days)
• Total Charges
• Occurrence Codes (qualifying hospital stay)
• Ensure proper reporting of PDPM per diem billing structure.
• Claim Submission & Follow-Up
• Submit claims electronically via EDI/clearinghouse or CMS DDE.
• Work with Medicare Administrative Contractors (MACs).
• Monitor claim status and resolve denials or RTPs.
• Submit corrected claims when MDS or HIPPS codes change.
• Payment Reconciliation & Post-Processing
• Post Medicare payments and reconcile PDPM variable per diem rates.
• Identify underpayments or discrepancies.
• Coordinate professional claims (CMS-1500) separately from facility billing.
• Compliance & Audit Readiness
• Ensure clinical documentation supports billed services.
• Maintain compliance with CMS and Medicare billing regulations.
• Assist with audits and ADR responses.
  

Required Qualifications

• Minimum 2–3 years of SNF Medicare Part A billing experience.
• Strong knowledge of PDPM reimbursement methodology.
• Experience working with MDS assessments and HIPPS coding.
• Proficiency in UB-04 (CMS-1450) claim preparation.
• Understanding of revenue codes 0022–0029.
• Familiarity with Medicare Administrative Contractors (MACs).
• Experience with electronic billing systems and clearinghouses.
• Strong attention to detail and regulatory compliance knowledge.
  
  

Preferred Qualifications

• RHIT, RHIA, CPC, or CPB certification.
• Experience in long-term care or post-acute care settings.
• Knowledge of Medicare Advantage SNF billing.
  
  

Core Competencies

• Knowledge of PDPM case-mix components (PT, OT, SLP, Nursing, NTA).
• Understanding of variable per diem adjustments.
• Ability to analyze MDS-driven reimbursement.
• Strong denial management skills.
• Excellent documentation review and audit readiness skills.
  
  

Interested candidates with SNF Medicare Billing Specialist are encouraged to apply by sharing their CV at:

[email protected]

• [email protected] Subject: SNF Medicare Billing Specialist