Medicare Specialist
New
O
Ovation HealthcareHealthcare billing
Source API remote eligibility restrictions: United StatesFull-TimeMiddle
Salary49,603.71 - 74,405.56 USD per year
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Job Details
- Experience
- 3-5 years of hospital Business Office billing and follow-up experience as a Medicare representative.
- Required Skills
- EHRHIPAA
Requirements
- Have 3-5 years of hospital Business Office billing and follow-up experience as a Medicare representative.
- Have experience utilizing payer portals, DDE, and client systems.
- Hold a high school diploma or equivalent.
- Have in-depth knowledge of Medicare billing codes, guidelines, and regulations.
- Be familiar with electronic health record (EHR) systems, billing software, remittance advice processing, and DDE.
- Understand HIPAA requirements and maintain confidentiality of sensitive information.
- Medical terminology, ICD-10, CPT, DRG, and third-party insurance payer guideline knowledge is preferred.
- Demonstrate accuracy in reviewing medical records and billing data.
- Be able to analyze claim data, identify billing errors, and troubleshoot complex claim issues.
Responsibilities
- Prepare and submit accurate Medicare claims in compliance with Medicare guidelines and regulations.
- Use DDE, CWF, and other tools to track and follow up on unpaid or denied Medicare claims.
- Review patient accounts and reconcile payments with Medicare remittance advice.
- Communicate with patients about Medicare coverage, billing questions, payment options, and outstanding balances.
- Investigate denied or underpaid claims and work with Medicare representatives and internal departments to resolve issues.
- Prepare and submit appeals and redeterminations for denied Medicare claims, including supporting documentation.
- Monitor aging reports and prioritize follow-up on overdue Medicare accounts.
- Maintain accurate claim, payment, communication, and follow-up records in the patient account system.
- Identify and resolve Medicare credit balances and request offsets to future payments in DDE.
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