Medicare Specialist – Medicare Billing

Job not on LinkedIn

🔥 6 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $23 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📊 Billing Specialist

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

SG Homecare

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

☁️ SaaS

💰 Private Equity Round on 2022-06

Healthcare • SaaS

SG Homecare is California's leader in Durable Medical Equipment and Supplies, with over 20 years of experience in providing essential services like Respiratory Therapies, Custom and Power Mobility solutions, Orthotics and Prosthetics, and Enteral Nutrition. The company focuses on a patient-centric approach, working closely with healthcare providers and organizations to deliver customized care programs that enhance the patient experience. SG Homecare is dedicated to utilizing cutting-edge technology and maintaining strong communication channels to ensure high patient satisfaction and improved health outcomes.

📋 Description

• Collaborate with global and domestic cross-functional teams to resolve patient questions, concerns, and issues related to Medicare coverage, claims, denials, and patient responsibility • Handle high-volume inbound and outbound calls related to Medicare billing statements, coverage, payment plans, and coordination of benefits (COB) • Accurately document all patient interactions, including inquiries, complaints, and resolutions, ensuring compliance with Medicare and internal documentation standards • Interpret EOBs and explain Medicare patient responsibility, coverage limitations, and claim outcomes • Verify insurance eligibility, benefits, and coverage through payer portals, with a focus on Medicare qualification and active coverage • Review and recalculate invoices as needed to ensure alignment with Medicare billing rules and reimbursement guidelines • Manage and resolve denials and appeals, ensuring proper documentation and adherence to Medicare requirements for medical necessity and claims processing including Medicare audits • Request and validate clinical documentation, prescriptions, and supporting records required to meet Medicare medical necessity standards • Coordinate with internal teams to ensure claims are clean, accurate, and ready for submission or resubmission • Respond to patient communications across multiple channels, including phone, email, portal, and fax • Route complex issues to appropriate teams while maintaining ownership of resolution • Ensure adherence to HIPAA, confidentiality, and Medicare compliance requirements at all times • Follow up on open tasks, worklists, and outstanding issues in a timely manner • Support equipment recovery processes when treatment ends or Medicare benefits terminate • Maintain knowledge of Medicare billing, reimbursement guidelines, and DMEPOS requirements

🎯 Requirements

• Minimum of 2 years of customer service experience, preferably in a role emphasizing ownership of the customer or patient financial experience • Minimum of 2 years of experience in healthcare, with extensive expertise to Medicare billing, RCM, or DMEPOS environments preferred • Understanding of healthcare terminology, with working knowledge of Medicare claims, EOBs, and patient responsibility • Strong customer service, problem-solving, and critical thinking skills, with the ability to navigate Medicare-related billing and coverage questions • Ability to manage high-volume inbound calls and communications while maintaining accuracy and compliance • Strong verbal and written communication skills, with the ability to explain Medicare billing, coverage, and denials in a clear and professional manner • High attention to detail, with the ability to identify and correct errors related to claims, documentation, and billing accuracy • Ability to multitask, prioritize, and follow through in a fast-paced, metrics-driven environment • Self-starter with the ability to work independently and collaboratively across teams • Flexible and adaptable to changing business needs, particularly in a growing Medicare-focused operation • Proficiency in billing systems and Microsoft Office 365; experience with Brightree or similar DME billing platforms preferred.