Medicare Account Resolution Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage pending Medicare claims that are unable to be processed, denied, or inaccurately paid, ensuring that each claim is appropriately addressed and returned to payment status.

• Review and resolve claims that are on hold by pinpointing the underlying reason for the hold, rectifying errors, and completing necessary follow-up actions.

• Assess Medicare denials for accuracy, determine subsequent steps, and execute appeals, adjustments, or resubmissions as necessary.

• Supply Medicare with additional documentation or relevant information essential for proper claim adjudication.

• Prepare, process, and monitor correspondence including letters, emails, supporting documents, and required refunds.

• Keep detailed and precise notes, documentation, and workflow updates within billing systems to facilitate claim progression and meet audit requirements.

• Carry out other job duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent is required.

• Proficient computer skills with a solid understanding of MS Outlook, Word, and Excel.

• Must be able to type at least 40 words per minute with accuracy.

• Demonstrated ability to handle high-volume workloads while adhering to tight deadlines.

• Experience in settings with call monitoring, productivity metrics, or performance scoring is preferred.

• Ability to maintain composure, professionalism, and effectiveness during phone interactions while upholding a positive company image.

• Exceptional written and verbal communication skills, capable of conveying information clearly and professionally.

• High level of attention to detail with strong accuracy in reviewing claims and documentation.

• Strong organizational and time-management skills with the ability to prioritize tasks and complete assigned responsibilities efficiently.

• Capability to independently manage all facets of the job role, including achieving required goals and adhering to business practices in a remote setting.

• Ability to talk, hear, and see clearly to read and interpret information.

• Regular use of a computer, phone, and standard office equipment.

• Ability to protect confidential information.

• Capability to work in a professional environment that is free from noise or distractions that could negatively impact customer experience.

• Must be available to work forty (40) hours per week as outlined by the schedule.

🏝️ Benefits

• Competitive salary, based on experience.

• Comprehensive benefits package.

• 401(k) Plan.

• Remote work arrangement.