Medicare Specialist

Job not on LinkedIn

🕒 May 26

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Ovation Healthcare

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 45 years

⚕️ Healthcare Insurance

☁️ SaaS

📚 Education

Healthcare Insurance • SaaS • Education

Ovation Healthcare is a leading provider of shared services for independent hospitals and health systems. With over 45 years of experience, the company enhances hospital and system performance through services like leadership advisory, supply chain management, revenue cycle management, technology services, and clinical care management. Ovation Healthcare is dedicated to supporting the financial and clinical needs of hospitals while preserving their focus on patient care and community wellness. Their educational programs and consulting services aim to strengthen hospital operations, making healthcare delivery more efficient and effective.

📋 Description

• 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 working to resolve any billing discrepancies with Medicare or patients. • Review patient accounts and reconcile payments with Medicare remittance advice, ensuring all 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 related 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 all 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 all Medicare claims, payments, communications, and follow-up activities, ensuring proper documentation in the patient account system.

🎯 Requirements

• In-depth knowledge of Medicare billing codes, guidelines, and regulations. • Ability to analyze complex data, identify patterns, and draw accurate conclusions. • Ability to analyze claim data, identify billing errors, and troubleshoot complex claim issues. • 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. • High level of accuracy in reviewing medical records and billing data. • Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously.

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements