Medicare Specialist

🕒 il y a 23 jours

🇺🇸 États-Unis – Télétravail

💵 $49 603 - $74 405 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👻 Score fantôme 1%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Ovation Healthcare

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 45 years

💼 Conseil

📦 Logistique

🏭 Fabrication

Consulting • Logistics • Manufacturing

Ovation Healthcare est un leader dans la fourniture de services partagés pour les hôpitaux indépendants et les systèmes de santé. Avec plus de 45 ans d'expérience, la société améliore la performance des hôpitaux et des systèmes grâce à des services tels que le conseil en leadership, la gestion de la chaîne d'approvisionnement, la gestion du cycle des revenus, les services technologiques et la gestion des soins cliniques. Ovation Healthcare se consacre à soutenir les besoins financiers et cliniques des hôpitaux tout en préservant leur concentration sur les soins aux patients et le bien-être de la communauté. Leurs programmes éducatifs et services de conseil visent à renforcer les opérations hospitalières, rendant la prestation des soins de santé plus efficiente et efficace.

Description

• 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 Medicare claims • Review patient accounts and reconcile payments with Medicare remittance advice • Communicate with patients regarding 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 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 and finance departments to resolve claim edit issues involving diagnosis and CPT codes • Prepare, submit, and follow up on redetermination appeals to Medicare

🎯 Exigences

• Experience utilizing Payer portals, DDE and client systems • 3-5 years of hospital Business Office billing and follow-up experience as a Medicare representative • Medical Terminology, ICD-10, CPT and DRG knowledge preferred • Knowledge of third-party Insurance payer guidelines • High school diploma or equivalent • Ability to analyze complex data, identify patterns, and draw accurate conclusions • High level of accuracy in reviewing medical records and billing data • In-depth knowledge of Medicare billing codes, guidelines, and regulations • Familiarity with electronic health record (EHR) systems, billing software, remittance advice processing, and DDE • Strong communication skills for explaining Medicare billing details and resolving patient concerns • Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations • Strong organizational skills and ability to manage multiple accounts simultaneously • Problem-solving abilities related to billing discrepancies and denied claims • Stable internet connection, quiet dedicated workspace, and necessary office equipment

🏖️ Avantages

• 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