Medicare Payments Specialist: Analysis & Compliance

Paylocity; Franklin (TN); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Disability insurance

Life insurance

Generous PTO

Employee events

Job summary

Prime Health Services (PHS) is seeking a Medicare Specialist to research and implement Medicare payment system methodologies within our product suite. You will work with Regulatory Compliance to apply Medicare rules to PIP and Workers' Compensation reimbursements and draft clear documentation for payment procedures.

The role involves maintaining Medicare policy rules in our bill review software, performing testing, and communicating issues to the Director of Compliance.

Qualifications

• Bachelor's degree in health care administration or related field. Related health care admin experience may substitute.
• Outpatient Coding Credential (CPC/COC/CCS-P preferred).
• Proficient with Microsoft Office (Excel, Word, PowerPoint).
• 2+ years in healthcare setting preferred (physician practice, hospital, payer, or IDN).
• Knowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, HCPCS, Medicare rules and OPPS.

Responsibilities

• Researches and deciphers complex legal and regulatory sources regarding Medicare payment rules.
• Collaborates with Regulatory Compliance on Medicare rules for Personal Injury Protection and Workers Compensation.
• Drafts concise documentation for payment procedures and translates them into user stories and project plans.
• Creates and updates internal documentation for Medicare products.
• Identifies issues and communicates clearly to team and leadership.
• Manages priorities and delivers high-quality information while meeting deadlines.
• Develops and maintains rules in PHS bill review software for Medicare policies.
• Reports showstopper issues to the Director of Compliance.
• Performs unit and acceptance testing as necessary.
• Performs other duties as assigned.

Skills

Healthcare administration

Medical coding knowledge

ICD-10CM knowledge

CPT4 knowledge

Office software

Problem solving

Education

Bachelor's Degree in health care administration

Tools

Microsoft Office Suite

Job description

Prime Health Services (PHS) is seeking a Medicare Specialist to research and implement Medicare payment system methodologies within our product suite. You will work with Regulatory Compliance to apply Medicare rules to PIP and Workers' Compensation reimbursements and draft clear documentation for payment procedures.

The role involves maintaining Medicare policy rules in our bill review software, performing testing, and communicating issues to the Director of Compliance.