Medicare Specialist

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
Medicare Specialists work with Medicare and/or Medicaid, and patients to resolve outstanding balances through research, follow ups and appeals. Epic experience required as well as Hospital Billing HB experience.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

- Edit and perform maintenance on Medicare claims.

- Follow-up on billed claims in a timely and effective manner.

- Maintain knowledge of current Medicare regulations and guidelines.

- Monitor patient accounts for accurate payment.

- Pursue account reimbursement through compliant action.

- Edit rejected claims in DDE which are identified on RTP report.

- Review patient bills for accuracy and completeness and obtaining any missing information.

- Utilization and adherence to Medicare guidelines.

- Other duties as assigned.

MINIMUM QUALIFICATIONS & REQUIREMENTS:

- 4+ years of experience resolving medical Medicare claims, expert Epic experience required

- High School Diploma or GED equivalent

- Knowledge of Medicare and/or Medicaid payors

- Familiarity with CPT and ICD-10 coding preferred

- Knowledge of insurance billing and medical terminology preferred

- Familiarity with electronic and paper systems used in billing healthcare services

- Ability to research unpaid or underpaid claims for resolution

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included.

It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Originally posted on Himalayas