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

Medical Reimbursement Specialists work with insurance carriers and patients to resolve outstanding balances through research, follow-ups, and appeals. This is a Remote Position.

Essential Duties And Responsibilities

• 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 obtain any missing information.
• Utilize and adhere to Medicare guidelines.
• Other duties as assigned.

Minimum Qualifications & Requirements

• A High School Diploma or GED equivalent.
• Two years (2) experience resolving medical Medicare claims.
• Knowledge of Medicare and/or Medicaid payors.
• Familiarity with CPT and ICD-10 coding preferred.
• Familiarity with insurance billing and medical terminology preferred.
• Knowledge of electronic and paper systems used in billing healthcare services.
• Ability to research unpaid or underpaid claims for resolution.

Physical Demands

• 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.