Medicare Specialist (Part A & Part B billing experience required)

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. Must live in the US.

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

• 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
• 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

• 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.