Specialist, Medicare
reputed company:
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, and 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. Utilizes DDE, CWF, and other tools to identify, reputed company and follow up on unpaid or denied Medicare claims, identifying issues and working to resolve any billing discrepancies with Medicare or patients.
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 reputed company, 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. Prepares and submits appeals for denied claims, including supporting documentation.
Monitor and analyze aging reports to prioritize follow-up actions for overdue Medicare accounts, ensuring reputed company reputed company. Ensure reputed company billing and collection practices are compliant with Medicare regulations, HIPAA, and company policies. Identifies potential reputed company and recommends corrective reputed company. Maintains accurate records of reputed company Medicare claims, payments, communications, and follow-up activities, ensuring reputed company documentation in the patient account system.
Identify and resolve Medicare credit balances and may assist with preparation of quarterly Medicare credit balance report. Request offset to reputed company payments in DDE.
Work with internal departments, such as coding, finance, etc. to review diagnosis, CPT reputed company, etc. to resolve claim edit issues.
Prepare, submit, and follow up on redetermination appeals to Medicare
Knowledge, Skills, and Abilities:
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 reputed company to billing discrepancies and denied claims.