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Medicare Specialist - Denials & Appeals in Nashville at Parallon

Date Posted: 1/10/2019

Job Snapshot

  • Employee Type:
  • Location:
  • Job Type:
  • Experience:
    At least 2 year(s)
  • Date Posted:

Job Description

JOB TITLE: Medicare Specialist
GENERAL SUMMARY OF DUTIES - Responsible for all aspects of Medicare receivable processing, including but not limited to, billing, collection, account and system maintenance, process reconciliation, and productivity reporting.
SUPERVISOR - Manager of Collections & Customer Service
• Maintains current knowledge of all office operations, job specific requirements and related regulations.
• Reviews all claims for completeness, reasonableness of charges, and appropriateness of billing codes, and payer information.
• Pursues timely collection of each claim using thorough follow-up efforts appropriate to each payer.
• Reviews, makes corrections to, and insures the legibility of outgoing secondary bills, and other correspondence before sending.
• Handles all incoming phone calls and inquiries in a appropriate manner.
• Properly processes and responds to incoming correspondence.
• Contacts and effectively communicates with all parties involved in the resolution of accounts placed.
• Completes work request timely and in accordance with instruction.
• Performs all of the task necessary to maintain current and accurate account information in each of the appropriate systems (i.e. entering notes, claims on hold).
• Forwards and logs all documentation related to processes and duties which are transferred to other employees.
• Brings problems and troubling accounts, as well as related questions, to his/her immediate supervisor’s attention daily.
• Exercised good judgment and makes sound decisions in the absence of detailed instructions or in a emergency situation.
• Treats client request with a high priority. Quickly informs supervisor and any other personnel needed to help carry out the request timely, accurately, and according to instruction.
• Strives to improve current operations by identifying inefficiencies and recurring problems, and by making suggestions to the immediate supervisor.
• Adapts and conforms to company and client requirements not specified in this job description/performance review.
• Promotes the Medicare Service Center and helps to identify the necessary resources to meet the needs of its customers.
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned
• Knowledge of Medicare regulations.
• Knowledge of UB-92 billing.
• Knowledge of 1500 billing.
• Knowledge of ICD-9 and CPT-4 coding.
• Analytical and organizational skills.
• Ability to identify, set, and follow priorities.
• Knowledge of hospital business office operations.
• Strong PC and data entry skills.
• Ability to communicate effectively with employees, clients, and others.
• Character to maintain strict confidentiality.
• High school graduate or equivalent.
• Minimum of 2 years Medicare claim processing experience.