Medicare Specialist

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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