医疗保险专家
Medicare Specialist
关于我们：
我们的目标是帮助客户实现其财务健康目标。在报销流程中，我们的可扩展解决方案和临床专业知识帮助解决程序性需求。通过领先的技术赋能我们的团队，使分析能够指导我们的解决方案，并确保我们达成目标。
我们通过投资于您来建立长期的职业生涯。我们致力于创造一个促进您职业发展和个人成长的环境，因为我们相信您的成功就是我们的成功。
职位概述：
医疗报销专家与保险公司和患者合作，通过研究、跟进和申诉解决未结余额。
这是一个远程职位。必须居住在美国。
核心职责和要求：
注意：以下核心职责和要求旨在描述该职位的一般职责和责任，并非对该职位职责的详尽陈述。该职位可能执行以下大部分主要职责。具体任务、责任或能力可能根据直接上级团队成员的绩效目标进行记录。
- 编辑和维护医疗保险索赔单。
- 及时有效地跟进已提交的索赔单。
- 保持对当前医疗保险法规和指南的了解。
- 监控患者账户以确保支付准确。
- 通过合规行动追求账户报销。
- 在RTP报告中识别出的DDE中编辑被拒的索赔单。
- 审核患者账单的准确性与完整性，并获取任何缺失的信息。
- 使用并遵守医疗保险指南。
- 其他指派的任务。
这是一个远程职位。必须居住在美国。
最低资格与要求：
- 高中文凭或同等学历
- 两年（2年）处理医疗保险索赔的经验
- 熟悉医疗保险和/或医疗补助付款方
- 熟悉CPT和ICD-10编码者优先
- 熟悉保险理赔和医学术语者优先
- 熟悉用于医疗保健服务计费的电子和纸质系统
- 能够研究未支付或部分支付的索赔单以进行解决
身体要求：
注意：为使有残疾的人员能够履行所描述的核心职责，可能会做出合理的调整。需要定期进行眼手协调和手动灵巧度操作办公设备。
查看英文原文
About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
Medical Reimbursement Specialists work with insurance carriers and patients to resolve outstanding balances through research, follow ups and appeals.
This is a REMOTE POSITION. Must live in the US.ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
- Edit and perform maintenance on Medicare claims.
- Follow-up on billed claims in a timely and effective manner.
- Maintain knowledge of current Medicare regulations and guidelines.
- Monitor patient accounts for accurate payment.
- Pursue account reimbursement through compliant action.
- Edit rejected claims in DDE which are identified on RTP report.
- Review patient bills for accuracy and completeness and obtaining any missing information.
- Utilization and adherence to Medicare guidelines.
- Other duties as assigned.
This is a REMOTE POSITION. Must live in the US.
MINIMUM QUALIFICATIONS & REQUIREMENTS:
- High School Diploma or GED equivalent
- Two years (2) experience resolving medical Medicare claims
- Knowledge of Medicare and/or Medicaid payors
- Familiarity with CPT and ICD-10 coding preferred
- Knowledge of insurance billing and medical terminology preferred
- Familiarity with electronic and paper systems used in billing healthcare services
- Ability to research unpaid or underpaid claims for resolution
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Originally posted on Himalayas