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 includes processing claims, managing accounts receivable, addressing patient inquiries, and working with Medicare representatives to resolve billing issues.

This position is 100% remote. The employee must have a stable internet connection, a quiet, dedicated workspace, and access to necessary office equipment. The work involves daily communication with team members, management, and clients through email, phone calls, video meetings, and other collaborative tools. It primarily requires sitting at a desk for extended periods; proper lighting and ergonomics should be maintained to reduce eye strain.

Requirements

• High school diploma or equivalent.
• 3–5 years of hospital Business Office billing and follow-up experience as a Medicare representative.
• Experience using payer portals, DDE, and client systems.
• In-depth knowledge of Medicare billing codes, guidelines, and regulations.
• Ability to analyze complex data, identify patterns, and draw accurate conclusions.
• High accuracy when reviewing medical records and billing data.
• Ability to analyze claim data, identify billing errors, and troubleshoot complex claim issues.
• Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing.
• Strong communication skills, including explaining Medicare billing details and resolving patient concerns.
• 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 regarding 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 in compliance with Medicare guidelines and regulations.
• Use DDE, CWF, and other tools to identify, track, and follow up on unpaid or denied Medicare 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 and resolve denied or underpaid Medicare claims with Medicare representatives and internal departments.
• Prepare and submit appeals for denied claims, including supporting documentation, and follow up on redetermination appeals to Medicare.
• 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 records of Medicare claims, payments, communications, and follow-up activities in the patient account system.
• Identify and resolve Medicare credit balances and may assist with preparing quarterly Medicare credit balance reports.
• Request offsets to future payments in DDE.
• Work with internal departments, including coding and finance, to review diagnoses, CPT codes, and other issues contributing to claim edits.

Benefits

• Comprehensive health and wellness benefits, including medical, dental, vision, life insurance, and short- and long-term disability coverage.
• HSA with employer contributions and flexible spending accounts for health care and dependent care.
• 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.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED