Opportunity Description
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.
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
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