Are you interested in joining a team of experienced healthcare experts and have
the ability to shape and transform the healthcare delivery system? At our family
of companies, everything we do is to help improve the lives of the nearly 12
million Medicare beneficiaries we serve and 700,000 health care providers who
care for them. It is our goal to help create a better health experience for all
consumers. Join our winning culture and help transform Medicare for the millions
of people who rely on its services.
Benefits info:
Medical, dental, vision, life and supplemental insurance plans effective the
first day of the month following date of hire
Short- and long-term disability benefits
401(k) plan with company match and immediate vesting
Free telehealth benefits
Free gym memberships
Employee Incentive Plan
Employee Assistance Program
Rewards and Recognition Programs
Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
Responds to Medicare Part A and/or B telephone and/or written inquiries from the
Medicare provider community which includes billing offices, medical societies,
provider consultants, Managed Care Organizations, attorneys, etc. regarding
Medicare coverage guidelines and policies covering a wide range of topics to
include provider enrollment, Medicare appeals, debt recovery, claim payment
information, telephone reopening requests, prior authorizations, and general
coverage for multiple provider specialties.
ESSENTIAL RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions. This list of
essential job functions is not exhaustive and may be supplemented as necessary.
Customer Service: (50%)
Engage in dialogue with all customers using a customer-friendly tone even when
challenged with overly aggressive customers.
Respond to each customer's need and request and ensure each customer's
encounter is positive and productive.
Use good verbal and written communication during each customer encounter and
never use jargon and slang.
Embrace diverse backgrounds and understand the needs of those customers who
may not have as extensive knowledge of Medicare rules and regulations. Tailor
responses to ensure customers receive the maximum benefit when calling Medicare.
May draft clear, concise, and accurate responses to written inquiries.
Research and Problem Identification: (25%)
Access multiple systems to research customer problems and record inquiry
types.
Research CMS and company websites to provide knowledge and education to
customer on additional resources which can be used in the future.
Access the Interactive Voice Recognition (IVR) and Internet Portal systems as
needed to help educate customers on self-service options that are available to
them.
Problem solving and Analysis: (25%)
Review claims processing systems to identify specific claim edits and audits
applied on claims.
Analyze claim edits and audits to determine reasons for claim denials.
Review debt recovery systems to troubleshoot reasons for pending accounts
receivables and the generation of overpayment demand letters. Review and analyze
data to determine reasons for overpayments.
Review local medical coverage and national medical coverage policies in order
to troubleshoot reasons for claim denials and reductions.
Review other systems to address and determine resolution to other customer
issues to include pending appeals, aged claims, prior authorization requests,
and Medicare Secondary Payer.
Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
High School Diploma or GED
1 year of related work experience; this includes experience in call center,
customer focus, or claims experience
Demonstrated internet and/or PC software navigation
Demonstrated strong problem solving and decision-making skills
Demonstrated good listening and strong verbal communication skills
PREFERRED QUALIFICATIONS
Post-secondary education/classwork
Experience in the insurance industry or medical coding or related work
experience
Qualifications
The Federal Government and the Centers for Medicare & Medicaid Services (CMS)
may require applicants to have lived in the United States for a minimum of three
(3) years out of the last five (5) years to be employed with the Company. These
years of residence do not have to be consecutive.
Background Investigation: If you are selected for this position, you must
undergo a pre-employment Background Investigation, Drug Screen, and Identity
Proofing documentation must be cleared prior to hire. Most positions are subject
to additional Identity Proofing, Fingerprinting and additional Background
Investigation screening conducted by the Federal Government to be granted
Enterprise User Administration (EUA) system logical access after you begin your
employment. Your continued employment is contingent upon the outcome of the
complete additional screening criteria required for the position which must find
that you meet the applicable government customer's requirements (e.g., suitable
for access to CMS information and information systems), as well as any
additional investigation which may be required throughout your employment. If
you are found not suitable, your employment may be subject to corrective action,
up to and including immediate termination of employment.
Identity Documentation: You must have access to a current and unrestricted REAL
ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent
Residency Documents. Note: Employment Authorization Cards (EAD) are not a
substitute for Visas or U.S. Permanent Resident Cards.
"We are an Equal Opportunity/Protected Veteran/Disabled Employer."
This opportunity is open to remote work in the following approved states: AL,
FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY.
Specific counties and cities within these states may require additional
approval. In FL and PA in-office and hybrid work may also be available.