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

1. 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).

2. 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.

3. 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.

4. 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.

5. 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.

6. 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:
careers@pmtac.com

a.arslan@pmtac.com
Subject: SNF Medicare Billing Specialist