Remote Medicare Claims & Reimbursement Specialist

Ovation Healthcare; United States; Remote; USD 50,000 - 74,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Paid time off

Company issued equipment

Job summary

Ovation Healthcare seeks a Medicare Specialist to manage Medicare billing and collections, ensuring compliance with policies and regulations. You will process claims, manage accounts receivable, and resolve patient questions while collaborating with Medicare representatives.

The role requires experience with DDE, CWF, and various billing tools, with a focus on accurate documentation and adherence to HIPAA. 100% remote work is offered.

Qualifications

• Ability to analyze complex data, identify patterns, and draw accurate conclusions.
• High level of accuracy in reviewing medical records and billing data.
• Ability to analyze claim data, identify billing errors, and troubleshoot complex claim issues.
• In-depth knowledge of Medicare billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing and DDE. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively.
• Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations. Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously. Problem-solving abilities, particularly with regard to billing discrepancies and denied claims.

Responsibilities

• Prepare and submit accurate Medicare claims for patient services, ensuring compliance with Medicare guidelines and regulations. Utilizes DDE, CWF, and other tools to identify, track and follow up on unpaid or denied Medicare claims.
• Review patient accounts and reconcile payments with Medicare remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed.
• Investigate and resolve issues related to denied or underpaid Medicare claims, including preparing appeals with supporting documentation.
• Monitor aging reports to prioritize follow-up actions for overdue Medicare accounts and ensure HIPAA compliance.
• Identify and resolve Medicare credit balances and assist with quarterly credit balance reports.
• Work with internal departments to review diagnosis and CPT codes to resolve claim edits.
• Prepare, submit, and follow up on redetermination appeals to Medicare

Skills

Data analysis

Attention to detail

Healthcare billing

HIPAA compliance

Communication skills

Education

High school diploma

3-5 years hospital billing experience

ICD-10/CPT/DRG knowledge

Tools

DDE

CWF

Job description

Ovation Healthcare seeks a Medicare Specialist to manage Medicare billing and collections, ensuring compliance with policies and regulations. You will process claims, manage accounts receivable, and resolve patient questions while collaborating with Medicare representatives.

The role requires experience with DDE, CWF, and various billing tools, with a focus on accurate documentation and adherence to HIPAA. 100% remote work is offered.