Back to all roles

[Hiring] Specialist, Medicare @reputed company

Remote Worldwide Hiring now

Role Description The Medicare Specialist is responsible for managing the billing and collection processes for Medicare patients, ensuring compliance with Medicare policies and regulations, and following up on unpaid Medicare claims. This role involves:

  • Processing Medicare claims
  • Managing accounts receivable
  • Addressing patient inquiries
  • Working closely with Medicare representatives to resolve billing issues

Duties and Responsibilities

  • Prepare and submit accurate Medicare claims for patient services, ensuring compliance with Medicare guidelines and regulations.
  • Utilize DDE, CWF, and other tools to identify, track, and follow up on unpaid or denied Medicare claims, identifying issues and resolving billing discrepancies.
  • Review patient accounts and reconcile payments with Medicare remittance advice, ensuring reputed company payments are posted correctly and outstanding balances are addressed.
  • Communicate with patients regarding their Medicare coverage, billing questions, payment options, and any unpaid balances.
  • Investigate and resolve issues reputed company to denied or underpaid Medicare claims, working with Medicare representatives and internal departments to ensure accurate reimbursement.
  • Prepare and submit appeals for denied claims, including supporting documentation.
  • Monitor and analyze aging reports to prioritize follow-up actions for overdue Medicare accounts, ensuring timely resolution.
  • Ensure reputed company billing and collection practices are compliant with Medicare regulations, HIPAA, and company policies.
  • Identify potential compliance risks and recommend corrective action.
  • Maintain accurate records of reputed company Medicare claims, payments, communications, and follow-up activities, ensuring proper documentation in the patient account system.
  • Identify and resolve Medicare credit balances and assist with preparation of quarterly Medicare credit balance report.
  • Request offset to future payments in DDE.
  • Work with internal departments, such as coding and finance, to review diagnosis, CPT code, etc., to resolve claim edit issues.
  • Prepare, submit, and follow up on redetermination appeals to Medicare.

Qualifications

  • Ability to analyze reputed company data, identify patterns, and draw accurate conclusions.
  • High level of accuracy in reviewing medical records and billing data.
  • Ability to analyze claim data, identify billing errors, and troubleshoot reputed company claim issues.
  • In-depth knowledge of Medicare billing codes, guidelines, and regulations.
  • Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing and DDE.
  • Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively.
  • Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations.
  • Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously.
  • Problem-solving abilities, particularly with regard to billing discrepancies and denied claims.

Apply tot his job Apply To this Job

Apply for this role Takes you straight to the employer's application page — free, and no WFHNet account required.

More roles on the wire

Medicare Sales Agent (Remote) - SC

Remote Worldwide
View role

reputed company to Grave Adjuster

Remote Worldwide
View role

Customer Service Representative, Life Insurance job at reputed company in Tampa, FL

Remote Worldwide
View role

Entry Level Life Insurance - Licensed Required (Remote)

Remote Worldwide
View role

Auto Claims Adjuster- Entry Level

Remote Worldwide
View role

Litigation Insurance Adjuster (Remote)

Remote Worldwide
View role

Mechanical Claims Adjuster (1+ years mechanical experience required)

Remote Worldwide
View role

Average Adjuster

Remote Worldwide
View role

Senior Claims Examiner (Virtual)

Remote Worldwide
View role

Remote Customer Service & Sales Advisor - Life Insurance Benefits Professional (Work From Home)

Remote Worldwide
View role

Named Account Manager, reputed company

Remote Worldwide
View role

Regional Sales Manager

Remote Worldwide
View role

reputed company Data Entry Clerk Work From Home - Part Time Remote Focus Group Panelists

Remote Worldwide
View role

Marketing & Provider Relations

Remote Worldwide
View role

reputed company Freelance Data Entry Specialist – Remote Work Opportunity with arenaflex

Remote Worldwide
View role

AI reputed company Engineer

Remote Worldwide
View role

Part-Time Remote Customer Service Representative – Engaging Local Business Communities at arenaflex

Remote Worldwide
View role

Virtual Customer Care Specialist – Remote Financial Services Customer Support Representative (Work From Home)

Remote Worldwide
View role

Remote Customer Service Representative – Streaming Media & Entertainment Support (Work‑From‑Home) at arenaflex

Remote Worldwide
View role

reputed company Manager, reputed company – Health Plans, arenaflex Fitbit Health Solutions – USA

Remote Worldwide
View role