医保专员
Specialist, Medicare
职位简介
欢迎加入Ovation Healthcare！
在Ovation Healthcare（前身为QHR Health），我们已经为本地医疗保健改善超过40年。我们的使命是加强独立社区医疗。我们为独立医院和医疗系统提供支持、指导和技术驱动的共享服务，以保持其强大和可持续性。凭借强烈的目标感和对运营卓越的承诺，我们帮助农村医疗机构实现其使命。
Ovation Healthcare的独特之处在于将运营经验和咨询指导相结合，以实现我们为医疗保健组织创造可持续未来的使命。Ovation Healthcare的愿景是成为一家动态、整合的专业服务公司，通过经验与思想领导力提供创新且可执行的解决方案，同时重视信任、尊重和以客户为中心的行为。
我们正在寻找有才华、有动力的专业人士，他们希望帮助独立医院蓬勃发展。在Ovation Healthcare工作，您将有机会与高技能的专家和运营高管合作，在专业和团队合作的氛围中工作。
Ovation Healthcare的总部位于田纳西州布伦特伍德。更多信息，请访问。
职位概述：
Medicare专员负责管理Medicare患者的账单和收款流程，确保符合Medicare政策和法规，并跟进未支付的Medicare索赔。该职位涉及处理Medicare索赔、管理应收账款、处理患者咨询，并与Medicare代表密切合作解决账单问题。
职责和要求：
- 准确准备并提交患者服务的Medicare索赔，确保符合Medicare指南和法规。使用DDE、CWF和其他工具识别、跟踪和跟进未支付或被拒的Medicare索赔，发现问题并努力与Medicare或患者解决任何账单差异。
- 审核患者账户并与Medicare的付款通知进行对账，确保所有付款正确记录，处理未结余额。与患者沟通其Medicare保险、账单问题、付款选项和任何未支付余额。
- 调查并解决与被拒或少付的Medicare索赔相关的问题。
查看英文原文
About the Job
Welcome to Ovation Healthcare!
At Ovation Healthcare (formerly QHR Health), we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.
The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare’s vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.
We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare, you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.
Ovation Healthcare’s corporate headquarters is located in Brentwood, TN. For more information, visit.
Summary:
The Medicare Specialist is responsible for managing the billing and collection processes for Medicare patients, ensuring compliance with Medicare policies and regulations, and following up on unpaid Medicare claims. This role involves processing Medicare claims, managing accounts receivable, addressing patient inquiries, and working closely with Medicare representatives to resolve billing issues.
Duties and Responsibilities:
- Prepare and submit accurate Medicare claims for patient services, ensuring compliance with Medicare guidelines and regulations. Utilizes DDE, CWF, and other tools to identify, track and follow up on unpaid or denied Medicare claims, identifying issues and working to resolve any billing discrepancies with Medicare or patients.
- Review patient accounts and reconcile payments with Medicare remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed. Communicate with patients regarding their Medicare coverage, billing questions, payment options, and any unpaid balances.
- Investigate and resolve issues related to denied or underpaid Medicare claims, working with Medicare representatives and internal departments to ensure accurate reimbursement. Prepares and submits appeals for denied claims, including supporting documentation.
- Monitor and analyze aging reports to prioritize follow-up actions for overdue Medicare accounts, ensuring timely resolution. Ensure all billing and collection practices are compliant with Medicare regulations, HIPAA, and company policies. Identifies potential compliance risks and recommends corrective action. Maintains accurate records of all Medicare claims, payments, communications, and follow-up activities, ensuring proper documentation in the patient account system.
- Identify and resolve Medicare credit balances and may assist with preparation of quarterly Medicare credit balance report. Request offset to future payments in DDE.
- Work with internal departments, such as coding, finance, etc. to review diagnosis, CPT code, etc. to resolve claim edit issues.
- Prepare, submit, and follow up on redetermination appeals to Medicare
Knowledge, Skills, and Abilities:
- Ability to analyze complex data, identify patterns, and draw accurate conclusions.
- High level of accuracy in reviewing medical records and billing data.
- Ability to analyze claim data, identify billing errors, and troubleshoot complex claim issues.
- In-depth knowledge of Medicare billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing and DDE. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively.
- 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 with regard to billing discrepancies and denied claims.
Work Experience, Education, and Certifications:
- Experience utilizing Payer portals, DDE and client systems
- 3-5 years of hospital Business Office billing and follow-up experience as a Medicare representative. Medical Terminology, ICD-10, CPT and DRG knowledge a preferred, knowledge of third-party Insurance payer guidelines
- High school diploma or equivalent
Working Conditions:
Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment. The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools. Primarily requires sitting at a desk for extended period. Proper lighting and ergonomics shole be maintained to reduce eye strain.
100% Remote
Benefits
The base compensation range for this position is:
$49,603.71 - $74,405.56
Compensation ranges could be hourly or salary depending upon the exempt status of the posted position. Compensation is only part of Ovation's total compensation package.
Some additional benefits offered to full-time associates are:
- Comprehensive health and wellness benefits such as medical, dental, vision, life insurance, short and long-term disability coverage
- HSA with employer contributions, flexible spending accounts for health care, and dependent care accounts
- Wellness platform with premium incentives
- Employee assistance support and additional voluntary supplemental plans including accident, critical illness, hospital indemnity, and child disability insurance
- Robust and flexible paid time off offerings and company paid holidays
- 401(k) plan with discretionary employer match opportunities
- Professional development opportunities
- Company issued equipment
Originally posted on Himalayas