Medicare Specialist

About Us

Xtend Healthcare is dedicated to helping clients surpass their financial health objectives. Through our comprehensive approach to the reimbursement cycle, we offer scalable solutions supported by clinical expertise to address various programmatic needs. Equipped with advanced technology and analytics, we ensure accountability and strive towards consistent goal achievement.

We are committed to building long-lasting careers by investing in the growth and development of our team members. We foster a supportive environment focused on both professional advancement and personal development because your success contributes to our overall success.

Job Overview

As a Medicare Specialist, you will collaborate with insurance companies and patients to resolve pending balances by conducting thorough research, follow-ups, and processing appeals. This position operates fully remotely.

Key Responsibilities

• Edit and maintain Medicare claims to ensure accuracy and compliance.
• Timely and efficient follow-up on billed claims to promote payment recovery.
• Stay informed about current Medicare rules and regulations.
• Monitor patient accounts to verify correct payments have been made.
• Actively pursue reimbursements through compliant and ethical means.
• Edit rejected claims in DDE identified through RTP reports.
• Review patient billing details to confirm completeness and verify missing data is obtained.
• Apply Medicare guidelines consistently during claim handling processes.
• Perform other duties as assigned by leadership.

Minimum Qualifications and Requirements

• Completion of High School Diploma or GED equivalent.
• A minimum of two years experience addressing and resolving Medicare medical claims.
• Knowledgeable in Medicare and/or Medicaid payor processes.
• Preferably familiar with CPT and ICD-10 medical coding standards.
• Understanding of insurance billing procedures and medical terminology is an advantage.
• Experience with both electronic and paper-based healthcare billing systems.
• Demonstrated ability to research unpaid or underpaid claims effectively to reach resolution.

Physical Demands

Reasonable accommodations are available to enable employees with disabilities to perform essential job functions. The role involves regular eye-hand coordination and manual dexterity to operate office equipment, and requires 6-8 hours of computer work daily amid potential distractions. Employees may need to sit for extended periods and occasionally lift or move items up to 20 pounds. During high workload periods with multiple deadlines, employees might experience elevated stress levels.

Additional Information

This job description serves as a guideline including key duties and essential functions but is not exhaustive. Additional responsibilities may be assigned as deemed necessary by supervisors to meet business needs.