Medicare Specialist

🔥 0 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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UofL Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

UofL Health is a fully integrated academic health system focused on delivering patient-centered care. It is a not-for-profit organization with nine hospitals, four medical centers, and over 250 physician practice locations, employing more than 1,200 providers in and around Louisville, Kentucky, including southern Indiana. Affiliated with the University of Louisville School of Medicine, UofL Health emphasizes advanced patient care and participates in clinical trials and research to enhance health outcomes. With a workforce of over 14,000 healthcare professionals, UofL Health aims to transform community health through innovation and compassion.

📋 Description

• Monitor and resolve claims holding on the discharged not final billed (DNFB) list • File claims electronically except for specified paper claims • Identify paper-submitted payers and communicate opportunities to leadership • Follow up on unpaid Medicare and Medicare Advantage claims • Maintain consistent follow-up on high-dollar accounts until resolved • Review and understand explanations of benefits/remittance advice • Generate statements for patient responsibility amounts • Use insurance websites to view and resolve claims • Perform extensive account follow-up and analyze problem accounts • Document follow-up efforts in the AR system • Submit shadow claims to Medicare for inpatient Medicare Advantage payers • Audit and research accounts, payment postings, and contractuals to confirm balance accuracy • Apply Medicare Secondary Payer Questionnaire guidelines for coordination of payment and coverage • Document and submit medical record requests in a timely manner • Contact patients, physician offices, attorneys, and others for information needed to process claims • Identify and report trends related to payment challenges • Maintain familiarity with the inpatient-only procedure list and help prevent denials • Work assigned accounts while meeting daily productivity goals and deadlines • Maintain HIPAA confidentiality and comply with company policies and standards • Demonstrate professionalism, customer service, collaboration, and support for patients, physicians, staff, and the broader healthcare community

🎯 Requirements

• High School Diploma or GED/Equivalent (required) • One (1) year of patient registration, billing, or equivalent experience (required) • Thorough knowledge of the Uniform Bill, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system • Knowledge of Medicare eligibility, benefits, primary payer determination, and covered benefits • Working knowledge of medical and insurance terms (preferred) • Ability to review, comprehend, and discuss HCFA billing with insurance or government agencies • Knowledge of general insurance requirements • Experience working directly with EOBs and contractual adjustments • Professional verbal and written communication abilities • Ability to meet productivity expectations and complete tasks by deadlines • Effective verbal and written communication • Ability to break down problems and identify causes and consequences • General computer knowledge and ability to learn and use relevant systems • Knowledge of HIPAA privacy and security requirements • Ability to maintain confidentiality and protect sensitive data

🏖️ Benefits

• Work from home / home office remote arrangement • First Shift schedule (8:00a–4:30p) • Seminars as requested • Access to UofL Health employee benefits is not specifically detailed in the posting