Medicare Follow-Up Representative

TeleSpecialists LLC•Brookhaven, GA

About The Position

We are seeking a detail-oriented Medicare Follow-Up Representative to support revenue cycle operations by managing claim follow-up, denials, appeals, and payment resolution for Medicare and secondary payers. This role requires strong experience with multi-state claims, Medicare Administrative Contractor (MAC) portals, telemedicine billing, and HCFA 1500 (CMS-1500) professional claims. The ideal candidate has hands-on experience with Medicare claim workflows, strong problem-solving skills, and the ability to efficiently resolve claim issues to maximize collections and reduce aging accounts receivable.

Requirements

2+ years of Medicare AR follow-up or payer collections experience
Strong working knowledge of Medicare claim processing and MAC portals
Experience with HCFA 1500 / CMS-1500 professional claim billing
Proven experience managing denials, appeals, and claim corrections
Experience handling multi-state claims and payer-specific requirements
Familiarity with telehealth and telemedicine billing workflows
Ability to interpret EOBs, ERAs, and remittance advice
Strong attention to detail, organization, and documentation skills
Ability to meet productivity goals in a fast-paced AR environment
Medicare payer expertise and portal navigation
Denial management and appeals resolution
Multi-state claim processing
Strong analytical and research skills
High attention to detail and compliance
Strong written documentation and communication skills
Time management and productivity discipline
Team collaboration and escalation judgment

Nice To Haves

Experience with tele-neurology or specialty telemedicine services
Experience submitting and managing Medicare appeals and redeterminations
Working knowledge of Salesforce (or CRM/workflow platforms)
Experience with Waystar clearinghouse and claim scrubbing tools
Experience working in telehealth or multi-state provider organizations
Familiarity with Medicare secondary and crossover claims
Prior experience with large AR inventories and aging reduction projects

Responsibilities

Conduct Medicare claim follow-up to resolve unpaid, denied, or pending claims
Work claims across multiple MAC portals (e.g.,Novitas, First Coast, Palmetto, Noridian, WPS, NGS)
Research and resolve claim denials, payment discrepancies, and rejections
Prepare and submit appeals, reconsiderations, and corrected claims when necessary
Review and correct claims billed on HCFA 1500 (CMS-1500) forms
Handle multi-state Medicare and commercial claims, ensuring payer-specific compliance
Follow up on telemedicine and tele-neurology claims, including place-of-service and modifier accuracy
Review EOBs/ERAs to ensure accurate posting and payment validation
Document claim activity and resolution notes in billing and workflow systems
Identify trends in denials and escalate recurring issues to leadership
Maintain productivity standards for claim volume, resolution timelines, and aging reduction
Collaborate with billing, coding, enrollment, and compliance teams to prevent repeat denials
Support AR cleanup initiatives and special payer projects as assigned