Medicare Specialist

Work from home Full-time role Hiring

Job Description:

Manage billing and collection processes for Medicare patients
Prepare and submit accurate Medicare claims in compliance with Medicare guidelines and regulations
Use DDE, CWF, and other tools to identify, track, and follow up on unpaid or denied claims
Review patient accounts and reconcile payments with Medicare remittance advice
Communicate with patients about Medicare coverage, billing questions, payment options, and unpaid balances
Investigate and resolve denied or underpaid claims with Medicare representatives and internal departments
Prepare and submit appeals and redetermination appeals for denied claims with supporting documentation
Monitor and analyze aging reports to prioritize follow-up on overdue Medicare accounts
Ensure billing and collection practices comply with Medicare regulations, HIPAA, and company policies
Maintain accurate records of claims, payments, communications, and follow-up activities
Identify and resolve Medicare credit balances and assist with quarterly Medicare credit balance reports
Request offsets to future payments in DDE
Collaborate with coding, finance, and other internal departments to resolve claim edit issues involving diagnoses and CPT codes

Requirements:

Experience utilizing Payer portals, DDE and client systems
3-5 years of hospital Business Office billing and follow-up experience as a Medicare representative
Knowledge of Medical Terminology, ICD-10, CPT, and DRG preferred
Knowledge of third-party Insurance payer guidelines
High school diploma or equivalent
In-depth knowledge of Medicare billing codes, guidelines, and regulations
Familiarity with electronic health record (EHR) systems, billing software, remittance advice processing, and DDE
Ability to analyze complex data and claim data, identify patterns and billing errors, and draw accurate conclusions
High level of accuracy in reviewing medical records and billing data
Strong communication skills for explaining Medicare billing details and resolving patient concerns
Ability to handle sensitive information confidentially in accordance with HIPAA regulations
Strong organizational and problem-solving skills; ability to manage multiple accounts simultaneously
Stable internet connection, quiet dedicated workspace, and necessary office equipment for remote work

Benefits:

Comprehensive health and wellness benefits such as medical, dental, vision, life insurance, short and long-term disability coverage
HSA with employer contributions
Flexible spending accounts for health care and dependent care accounts
Wellness platform with premium incentives
Employee assistance support
Voluntary supplemental plans including accident, critical illness, hospital indemnity, and child disability insurance
Robust and flexible paid time off offerings
Company paid holidays
401(k) plan with discretionary employer match opportunities
Professional development opportunities
Company issued equipment

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