Medicare Specialist

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $49.6k - $74.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 3%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Ovation Healthcare

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 45 years

💼 Consulting

📦 Logistics

🏭 Manufacturing

Consulting • Logistics • Manufacturing

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 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

🎯 Requirements

• 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

🏖️ Benefits

• 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