Medicare Specialist

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

📋 Description

• Oversee and resolve claims that are listed as discharged but not final billed (DNFB).

• Electronically submit claims, with the exception of designated paper claims.

• Identify payers that submit claims on paper and inform leadership about potential improvements.

• Follow up on unpaid claims for Medicare and Medicare Advantage.

• Ensure regular follow-up on high-value accounts until they are resolved.

• Review and interpret explanations of benefits and remittance advice.

• Generate statements reflecting amounts owed by patients.

• Utilize insurance websites to check and resolve claims issues.

• Conduct thorough account follow-ups and analyze accounts with problems.

• Record follow-up activities in the accounts receivable system.

• Submit shadow claims to Medicare for inpatient Medicare Advantage payers.

• Audit and investigate accounts, payment postings, and contracts to verify the accuracy of balances.

• Apply guidelines from the Medicare Secondary Payer Questionnaire to coordinate payment and coverage.

• Timely document and submit requests for medical records.

• Reach out to patients, physician offices, attorneys, and others for necessary information to process claims.

• Identify and report trends related to payment difficulties.

• Keep informed about the inpatient-only procedure list to help avoid denials.

• Manage assigned accounts while achieving daily productivity targets and deadlines.

• Uphold HIPAA confidentiality and adhere to company policies and standards.

• Exhibit professionalism, customer service skills, teamwork, and support for patients, physicians, staff, and the wider healthcare community.

⛳️ Requirements

• High School Diploma or GED/Equivalent (mandatory).

• At least one (1) year of experience in patient registration, billing, or a related field (mandatory).

• Comprehensive understanding of the Uniform Bill, Medicare and Medicare Advantage billing processes, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system.

• Familiarity with Medicare eligibility, benefits, primary payer determination, and covered services.

• Preferred knowledge of medical and insurance terminology.

• Capability to review, understand, and discuss HCFA billing with insurance or government entities.

• Awareness of general insurance requirements.

• Experience working directly with EOBs and handling contractual adjustments.

• Strong verbal and written communication skills.

• Ability to meet productivity standards and complete tasks within set deadlines.

• Proficient in verbal and written communication.

• Skill in analyzing problems to determine causes and implications.

• General computer literacy and the capacity to learn and utilize relevant systems.

• Understanding of HIPAA privacy and security regulations.

• Ability to maintain confidentiality and safeguard sensitive information.

🏝️ Benefits

• Flexible work-from-home or remote office arrangement.

• First Shift schedule (8:00 AM – 4:30 PM).

• Seminars available upon request.

• Access to UofL Health employee benefits, specifics not outlined in this posting.