Specialist, Medicare

Ovation Healthcare•Crest, CA

1d•$49,604 - $74,406•Remote

About The Position

The Medicare Specialist manages billing and collection processes for Medicare patients, ensuring compliance with Medicare policies and regulations and following up on unpaid claims. The role processes claims, manages accounts receivable, responds to patient inquiries, and works with Medicare representatives and internal departments to resolve billing issues. The position is 100% remote and requires a stable internet connection, a quiet and dedicated workspace, and access to necessary office equipment. The specialist communicates daily with team members, management, and clients using email, phone, video meetings, and other collaborative tools. Work primarily involves sitting at a desk for extended periods, with proper lighting and ergonomics to reduce eye strain. The stated base compensation range is $49,603.71–$74,405.56. Compensation may be hourly or salary depending on exempt status and is determined using factors including location, qualifications, skills, certifications, and experience. Full-time benefits include health and wellness coverage, paid time off and holidays, a 401(k) plan with discretionary employer match opportunities, professional development, and company-issued equipment.

Requirements

3–5 years of hospital Business Office billing and follow-up experience as a Medicare representative.
Experience using payer portals, DDE, and client systems.
High school diploma or equivalent.
In-depth knowledge of Medicare billing codes, guidelines, and regulations.
Familiarity with electronic health record systems, billing software, remittance advice processing, and DDE.
Ability to analyze complex data, identify patterns, and draw accurate conclusions.
Accuracy in reviewing medical records and billing data, and ability to identify billing errors and troubleshoot complex claim issues.
Strong communication skills and ability to explain Medicare billing details and resolve patient concerns.
Ability to handle sensitive information confidentially in accordance with HIPAA regulations.
Strong organizational and detail-oriented skills, with the ability to manage multiple accounts simultaneously.
Problem-solving ability, particularly with billing discrepancies and denied claims.

Nice To Haves

Knowledge of medical terminology, ICD-10, CPT, and DRG.
Knowledge of third-party insurance payer guidelines.

Responsibilities

Prepare and submit accurate Medicare claims for patient services in compliance with Medicare guidelines and regulations.
Use DDE, CWF, and other tools to identify, track, and follow up on unpaid or denied claims, resolving billing discrepancies with Medicare or patients.
Review patient accounts and reconcile payments with Medicare remittance advice; ensure payments are posted correctly and outstanding balances are addressed.
Communicate with patients about Medicare coverage, billing questions, payment options, and unpaid balances.
Investigate denied or underpaid claims with Medicare representatives and internal departments to ensure accurate reimbursement.
Prepare and submit appeals for denied claims, including supporting documentation, and follow up on Medicare redetermination appeals.
Monitor and analyze aging reports to prioritize follow-up on overdue Medicare accounts.
Ensure billing and collection practices comply with Medicare regulations, HIPAA, and company policies; identify potential compliance risks and recommend corrective action.
Maintain accurate documentation of claims, payments, communications, and follow-up activities in the patient account system.
Identify and resolve Medicare credit balances, assist with quarterly Medicare credit balance reports, and request offsets to future payments in DDE.
Work with internal departments, including coding and finance, to review diagnoses and CPT codes and resolve claim-edit issues.

Benefits

Comprehensive health and wellness benefits, including medical, dental, vision, life insurance, and short- and long-term disability coverage.
HSA with employer contributions, flexible spending accounts for health care, and dependent care accounts.
Wellness platform with premium incentives.
Employee assistance support and voluntary supplemental plans, including accident, critical illness, hospital indemnity, and child disability insurance.
Flexible paid time off offerings and company-paid holidays.
401(k) plan with discretionary employer match opportunities.
Professional development opportunities.
Company-issued equipment.

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