Medicare Specialist

Elevate Patient Financial Solutions®; United States; Remote; USD 45,000 - 60,000; Full time

Benefits offered by this job

Medical Insurance

401K

PTO

Holiday pay

Pet Insurance

Referral bonus

Job summary

Elevate Patient Financial Solutions® is seeking a Medicare Specialist to resolve aged and denied Medicare claims and manage accounts for hospital or physician groups. This remote, full-time role reports to the manager and uses the Medicare DDE system and Part B websites for review and resolution.

The ideal candidate has Medicare claims experience, can navigate CMS.gov and related portals, and maintains accurate notes while meeting production goals.

Qualifications

• High school diploma or GED required; college preferred.
• Minimum 1–2 years’ experience with traditional Medicare claims.
• Ability to type 50 wpm and work independently in remote settings.

Responsibilities

• Resolve aged/denied Medicare claims and determine appropriate actions.
• Review claims status (UB/HCFA) and post adjustments.
• Work denials and appeals in a timely manner.
• Navigate CMS.gov and intermediary websites; use DDE system.
• Maintain accurate account notes and communicate with clients.

Skills

Typing 50 wpm

Medicare DDE

CMS.gov navigation

Claims denial & appeals

Billing electronic claims

ICD-9/ICD-10 knowledge

Education

High School Diploma or GED

Some college preferred

College degree optional

Tools

Medicare DDE system

Connex

C-Snap

Job description

Elevate Patient Financial Solutions has an exciting career opportunity available as a Medicare Specialist. This position will be located in remote. The Full-Time schedule for this role will be Monday-Friday 8:00am-5:00pm.

Job Summary

As a Medicare Specialist, you will be instrumental in helping resolve aged medical claims, outstanding claims and denied claims to determine the appropriate course of action. A Medicare Specialist is responsible for the Medicare accounts for multiple hospital or physician groups. These accounts will be assigned by the manager for review and resolution with the use of the Medicare DDE system and Part B websites such as Connex and C-Snap

Essential Duties And Responsibilities

• Resolve cash generating accounts expeditiously to bring in revenue for the client and the company.
• Able to review Medicare claims to determine status (UB/HCFA)
• Able to post adjustments on various facility systems
• Must have the ability to work denials and appeals in a timely manner
• Experience in billing electronic claims
• Driven to resolve claims on first touch
• Proficiently navigate through CMS.Gov websites as well as the intermediary websites
• Working knowledge of ICD-9 and ICD-10, CPT, revenue codes, HCPCS and modifiers
• Able to work in the Medicare DDE/FISS (Direct Data Entry) system: (Hospital only)
• Check Claim status in DDE
• Know the condition codes for adjusting and canceling claims
• Enter/correct/adjust/cancel claims
• Able to rekey a claim directly into the DDE system
• Make correction to RTP claims (returned to provider)
• Able to interpret eligibility information on CWF and HIQA
• Develops a solid understanding of assigned client processes in order to review and analyze claims and account receivable functions.
• Include key information in account notes consistently
• Able to ask questions, if unclear, on facility specifics or company processes.
• Able to use the appropriate reason and status codes in the company software for each account
• Able to request the correct information from the appropriate entity when attempting to resolve the account.
• Maintain the minimum production criteria for the various client assigned
• Maintain a 5% or less error ratio
• Regular and timely attendance.
• Other duties as assigned.

Qualifications And Requirements

• High School Diploma or GED.
• Some college preferred or college degree.
• Minimum 1-2 years’ experience in working traditional Medicare claims.
• Minimum of 1-2 years’ experience in working in DDE Direct Data Entry system.
• Able to type 50 wpm
• Team-oriented but also able to work independently
• Strong organizational skills.
• Excels at time-management.
• Able to adapt to change.
• Proven success at building strong working relationships with coworkers and management.
• Beneficial to have worked in one or more Health Information Systems: Epic physicians or hospital, Meditech, Invision, AS400, Citrix, IDX, Nextgen, Allscript Physicians or hospital, Centricity, Soarian, Series & HBOC Star, Cerner, Practice Plus, TMHP and other Medicaid sites.
• Remote and Hybrid positions require internet connections that meet the Company’s upload and download speed criteria.

Benefits:

• Medical, Dental & Vision Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 Elevate Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We believe in teamwork and having fun together
• Career Growth: Gain great experience to promote to higher roles

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

ElevatePFS is an Equal Opportunity Employer