Medicare Specialist

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

📋 Description

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

• Utilize DDE, CWF, and additional tools to identify, track, and follow up on unpaid or denied Medicare claims.

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

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

• Investigate and resolve denied or underpaid claims by collaborating with Medicare representatives and internal departments.

• Prepare and submit appeals for denied claims, ensuring all necessary supporting documentation is included.

• Monitor and analyze aging reports to prioritize follow-up actions on overdue Medicare accounts.

• Ensure that billing and collection practices conform to Medicare regulations, HIPAA standards, and company policies.

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

• Identify and rectify Medicare credit balances, assisting with quarterly Medicare credit balance reports.

• Request offsets to future payments through DDE.

• Work in conjunction with coding and finance departments to resolve claim edit issues related to diagnosis and CPT codes.

• Prepare, submit, and follow up on redetermination appeals to Medicare.

⛳️ 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.

• Preferred knowledge of Medical Terminology, ICD-10, CPT, and DRG.

• Understanding of third-party insurance payer guidelines.

• High school diploma or equivalent required.

• Strong analytical skills for complex data, with the ability to identify patterns and draw accurate conclusions.

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

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

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

• Excellent communication skills for explaining Medicare billing details and addressing patient concerns.

• Capability to handle sensitive information while maintaining confidentiality in line with HIPAA regulations.

• Strong organizational skills and the ability to manage multiple accounts effectively.

• Problem-solving skills relevant to billing discrepancies and denied claims.

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

🏝️ Benefits

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

• Health Savings Account (HSA) with employer contributions.

• Flexible spending accounts for health care and dependent care expenses.

• Access to a wellness platform with 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 discretionary employer matching opportunities.

• Opportunities for professional development.

• Company-issued equipment provided.