医疗保险账户解决专员 - 数字技术 - 远程
Medicare Account Resolution Specialist - Digitech - Remote
Sarnova 集团旗下包括 Digitech Computer、Bound Tree Medical、Tri-anim Health Services、Cardio Partners 和 Emergency Medical Products
Digitech 是 EMS 运输行业领先的高级计费和技术服务提供商。自 1984 年成立以来，Digitech 不断优化其软件平台，打造基于云的计费和商业智能解决方案，用于监控和自动化整个 EMS 收入生命周期。Digitech 利用其专有技术，提供全面外包服务，以最大化回款、保护合规性，并为客户提供成果。
职位概述：
Medicare 账户解决专员负责在提交 Medicare 索赔后进行管理和解决，以确保准确及时的处理。该职位需要强大的分析能力、出色的关注细节能力，以及在快节奏的计费环境中管理多项任务的能力。理想的候选人应细致、可靠，并具备熟练处理 Medicare 指南、拒付和后续流程的技能。
主要职责和工作内容：
- 处理待定、无法释放、被拒或错误支付的 Medicare 索赔，确保每笔索赔得到适当解决并恢复付款状态
- 审核并解决被搁置的索赔，识别搁置原因，纠正错误，并完成所有必要的后续操作
- 分析 Medicare 拒付情况，确定准确性，识别下一步措施，并根据需要完成上诉、调整或重新提交
- 向 Medicare 提供任何必要的额外文件或信息，以确保索赔正确处理
- 准备、处理和跟踪信件、电子邮件、支持文件和所需退款等沟通内容
- 在计费系统中保持详细且准确的记录、文档和工作流程更新，以支持索赔进展和审计要求
- 其他指定的工作职责
所需的技能/经验：
- 教育背景：需高中文凭或同等学历
- 强大的计算机技能，包括对 MS Outlook、Word 和 Excel 的熟练使用
- 能够以 40 WPM 的速度准确打字
- 有处理高工作量、有效优先排序并按时完成任务的经验
- 有电话监控、生产率指标或绩效评分环境的工作经验者优先考虑
- 在电话交流中能够保持冷静、专业和高效，同时维持良好的沟通表现
查看英文原文
The Sarnova Family of companies includes Digitech Computer, Bound Tree Medical, Tri-anim Health Services, Cardio Partners, and Emergency Medical Products
Digitech is a leading provider of advanced billing and technology services to the EMS transport industry. Since its founding in 1984, Digitech has refined its software platform to create a cloud-based billing and business intelligence solution that monitors and automates the entire EMS revenue lifecycle. Digitech leverages its proprietary technology to offer fully outsourced services that maximize collections, protect compliance, and deliver results for clients.
Summary:
The Medicare Account Resolution Specialist is responsible for managing and resolving Medicare claims after submission to ensure accurate and timely processing. This role requires strong analytical skills, exceptional attention to detail, and the ability to manage multiple tasks in a fast-paced billing environment. The ideal candidate is thorough, dependable, and skilled at navigating Medicare guidelines, denials, and follow-up processes.
Essential Duties and Responsibilities:
- Work Medicare claims that are pending, unable to be released, denied, or paid incorrectly, ensuring each claim is resolved appropriately and returned to payment status
- Review and resolve claims placed on hold by identifying the reason for the hold, correcting errors, and completing all required follow up actions
- Analyze Medicare denials to determine accuracy, identify next steps, and complete appeals, adjustments, or resubmissions as needed
- Provide Medicare with any additional documentation or information necessary for accurate claim adjudication
- Prepare, process, and track correspondence such as letters, emails, supporting documents, and required refunds
- Maintain detailed and accurate notes, documentation, and workflow updates within billing systems to support claim progression and audit requirements
- Additional job duties as assigned
Skills/Experience Required:
- Education: High School Diploma or equivalent required
- Strong computer skills, including working knowledge of MS Outlook, Word, and Excel
- Ability to type 40 WPM with accuracy
- Proven ability to handle high volume workloads, prioritize effectively, and meet tight deadlines
- Experience in an environment with call monitoring, productivity metrics, or performance scoring is preferred
- Ability to remain calm, professional, and effective during phone interactions while maintaining a positive company image
- Excellent written and verbal communication skills, with the ability to explain information clearly and professionally
- High attention to detail with strong accuracy in claim review and documentation
- Strong organizational and time management skills with the ability to prioritize work and complete assigned tasks efficiently
- Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment
Physical Requirements:
- Ability to talk, hear, and see clearly to read and interpret information
- Regular use of a computer, phone, and standard office equipment
- Ability to secure confidential information
- Perform all duties in a professional environment free of noise or anything that would create a negative customer experience
Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Sarnova is an Equal Opportunity Employer. We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EO/M/F/Veterans/Disabled. Our mission is to be the best partner for those who save and improve patients’ lives. Excellence in delivering upon our mission is dependent upon having a diverse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values diversity. #digitech
Originally posted on Himalayas