Medicare Qualification Specialist

VetJobs; Center Square (PA); On-site; USD 29,000 - 32,000; Full time

Job summary

Ethos Therapy Solutions in Blue Bell, Pennsylvania, is hiring a Continued Qualification Medicare Specialist to ensure continued therapy is eligible and properly documented. You will verify active coverage, gather payer-required documentation, and coordinate with providers and internal teams to maintain compliant, audit-ready files.

You will work with insurance payers to minimize denials, support timely reauthorization, and help patients receive medically necessary equipment, while adhering to

Qualifications

• High school diploma or equivalent; healthcare admin or billing training preferred.
• Direct Medicare experience required.
• Proven insurance verification experience in healthcare.
• Familiar with CPT/ICD-10 and medical terminology.
• Proficient with EHR, billing software and insurance databases.

Responsibilities

• Acquire deep understanding of Ethos products and their home-use application.
• Contact patients to verify active coverage and therapy compliance.
• Coordinate with providers to obtain payer documentation for therapy in home.
• Maintain accurate, real-time records of visits, demographics and authorizations.
• Assess eligibility and obtain timely insurance reauthorization for continued therapy.
• Escalate cases with potential claim delays or denials.
• Collaborate with billing to ensure accurate claim submissions and documentation.

Skills

Strong communication

Attention to detail

Organizational skills

Customer service

Problem solving

HIPAA compliance

Education

High School diploma or equivalent

Healthcare administration / medical billing preferred

Tools

EHR systems

Billing software

Insurance databases

Job description

Ethos Therapy Solutions in Blue Bell, Pennsylvania, is hiring a Continued Qualification Medicare Specialist to ensure continued therapy is eligible and properly documented. You will verify active coverage, gather payer-required documentation, and coordinate with providers and internal teams to maintain compliant, audit-ready files.

You will work with insurance payers to minimize denials, support timely reauthorization, and help patients receive medically necessary equipment, while adhering to