- Experience
- 2+ yrs
- Salary
- —
- Openings
- 1
- Posted
- 4 weeks ago
- Work mode
- In office
- Education
- High School Diploma or GED
- Eligibility
- Candidates with a high school diploma or GED and at least 2 years of experience resolving Medicare claims are eligible to apply. Familiarity with Medicare/Medicaid payers and billing workflows is expected, while CPT/ICD-10 and medical terminology knowledge are preferred.
- Resume
- Required to apply
Where you'll work
Job description
About the Organization
The company focuses on helping clients achieve stronger financial outcomes through the reimbursement cycle. Its services combine scalable processes, clinical expertise, and technology-driven analytics to address program needs while keeping results accountable.
It also emphasizes long-term career growth by investing in employees and fostering an environment that supports both professional development and personal advancement.
Role Summary
The Medicare Specialist is responsible for working with insurers and patients to address unpaid balances through investigation, follow-up activity, and appeal handling.
Primary Duties
- Review, update, and maintain Medicare claims information.
- Track billed claims and complete follow-ups in a prompt and effective way.
- Stay current on Medicare rules, regulations, and billing guidelines.
- Monitor patient accounts to ensure payments are posted accurately.
- Take compliant steps to recover reimbursement on outstanding accounts.
- Correct rejected claims in DDE that appear on RTP reports.
- Check patient bills for completeness and accuracy, and gather any missing details.
- Apply Medicare policy requirements consistently in daily work.
- Carry out additional tasks as needed.
Minimum Qualifications
- High school diploma or GED is required.
- At least 2 years of experience handling Medicare claim resolution is required.
- Working knowledge of Medicare and/or Medicaid payers is expected.
- Experience with CPT and ICD-10 coding is preferred.
- Knowledge of medical terminology and insurance billing is preferred.
- Comfort with both electronic and paper-based billing systems is required.
- Ability to investigate unpaid or underpaid claims and work toward resolution is required.
Physical and Work Conditions
Reasonable accommodations may be provided for individuals with disabilities. The role requires frequent eye-hand coordination and manual dexterity for office equipment use. Work is typically performed at a computer terminal for 6 to 8 hours per day in an environment with ongoing interruptions. The position may involve extended sitting. Occasionally, the employee may need to lift and move materials weighing up to 20 lbs. Stress levels may rise during busy periods and when multiple deadlines overlap.
Additional Notes
This job description serves as a general guide and does not list every possible duty, responsibility, skill, or qualification. Supervisors may assign additional functions and requirements as needed.