Sr. Medicare Associate

Sedgwick•St. David's, IL

7d•Onsite

About The Position

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Sr. Medicare Associate PRIMARY PURPOSE To gather documentation required to complete Medicare Compliance referrals in a timely manner; to upload referrals to Medicare Compliance System (MCS); to review the pay histories and medical records for adequacy; and to resolve technically difficult record files.

Requirements

High school diploma or GED required.
One (1) year of general office experience required.
Two (2) years of experience as Medicare Associate required.
Excellent oral and written communication skills, PC literate, including Microsoft Office products, analytical and interpretive skills, and ability to meet or exceed Performance Competencies
Computer keyboarding
Hearing, vision and talking
Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Nice To Haves

Claims or medical records/billing industry experience preferred.

Responsibilities

Reviews JURIS pay ledger as a guide to locate medical records needed for MCS assignment; analyzes additional records to determine if they are pertinent to Medicare Set Aside (MSA); and determines appropriate course of action.
Pulls and sorts medical records required for complex Medicare Compliance referral from appropriate sources; identifies missing document/records; requests missing documentation from provider, examiner and/or defense counsel.
Handles complex records issues by identifying and seeking out critical records to create a file that meets government requirements.
Reviews and submits medical records to nurses to enable them to complete referral in a timely manner; uploads referrals and reports from claims system into MCS; ensures MCS is updated properly.
Responds to questions from examiners about Medicare Compliance processes and products.
Documents activity in MCS; communicates MCS action with examiner via JURIS notes.
Creates daily reports to manage workload and monitors due dates.
Communicates with examiners and defense counsel to resolve technically difficult issues related to obtaining medial records.
Assists in training new departmental colleagues.
Assists with special client projects as needed.