Medicare Specialist

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

📋 Description

• Oversee billing and collections for Medicare patients.

• Accurately prepare and submit Medicare claims in line with guidelines and regulations.

• Utilize DDE, CWF, and other resources to identify, monitor, and follow up on outstanding or denied claims.

• Review patient accounts and reconcile payments with Medicare remittance advice.

• Engage with patients regarding Medicare coverage, billing inquiries, payment alternatives, and outstanding balances.

• Investigate and resolve issues related to denied or underpaid claims in collaboration with Medicare representatives and internal departments.

• Prepare and submit appeals and redetermination requests for denied claims, including necessary supporting documentation.

• Monitor and assess aging reports to prioritize follow-ups on overdue Medicare accounts.

• Ensure compliance of billing and collection practices with Medicare regulations, HIPAA, and company policies.

• Maintain precise records of claims, payments, communications, and follow-up actions.

• Identify and resolve Medicare credit balances while assisting with quarterly reports on credit balances.

• Request offsets to future payments through DDE.

• Collaborate with coding, finance, and other internal teams to address claim edit issues related to diagnoses and CPT codes.

⛳️ Requirements

• Experience with Payer portals, DDE, and client systems.

• 3-5 years of experience in hospital Business Office billing and follow-up as a Medicare representative.

• Familiarity with Medical Terminology, ICD-10, CPT, and DRG is preferred.

• Knowledge of third-party insurance payer guidelines.

• High school diploma or equivalent is required.

• Extensive knowledge of Medicare billing codes, guidelines, and regulations.

• Experience with electronic health record (EHR) systems, billing software, remittance advice processing, and DDE.

• Ability to analyze complex claim data, recognize patterns and billing errors, and draw accurate conclusions.

• High level of accuracy in reviewing medical records and billing information.

• Strong communication skills to explain Medicare billing details and address patient concerns.

• Capability to manage sensitive information confidentially in accordance with HIPAA regulations.

• Strong organizational and problem-solving skills, with the ability to manage multiple accounts concurrently.

• Reliable internet connection, a quiet dedicated workspace, and necessary office equipment for remote work.

🏝️ Benefits

• Comprehensive health and wellness benefits including medical, dental, vision, life insurance, and both short and long-term disability coverage.

• Health Savings Account (HSA) with employer contributions.

• Flexible spending accounts available for healthcare and dependent care expenses.

• Access to a wellness platform offering premium incentives.

• Employee assistance support services.

• Optional supplemental plans including accident, critical illness, hospital indemnity, and child disability insurance.

• Generous and flexible paid time off policies.

• Company-paid holidays.

• 401(k) plan with potential employer match opportunities.

• Opportunities for professional development.

• Company-issued equipment provided.