Medicare Specialist (Remote) Jobs

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Medicare Specialist (Remote)

PRIMARY PURPOSE: To coordinate, analyze and facilitate Medicare Compliance and Medicare Set-Aside (MSA) functions within the assigned team.

ESSENTIAL FUNCTIONS And RESPONSIBILITIES

• Analyzes and processes complex claims by investigating and gathering information to determine the exposure on the claims; manages claims through well-developed action plan to an appropriate and timely resolution.
• Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses’ analysis.
• Communicates and advises appropriate internal and external stakeholders on Medicare Compliance and Medicare Set-Aside (MSA) matters including, but not limited to, lien negotiation efforts, MSA submissions and/or general information.
• Compiles, reviews and analyzes claim files and/or management reports.
• Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
• Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
• Maintains thorough understanding of service and products offered by Medicare Compliance department.

ADDITIONAL FUNCTIONS And RESPONSIBILITIES

• Supports the organization's quality program(s).
• Travels as required.
• Performs other duties as assigned.

Qualifications

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Four (4) years claims management experience or equivalent combination of experience and education required. Experience with Medicare issues preferred.

Skills & Knowledge

• Thorough knowledge of claims management
• Strong organizational skills
• Ability to work in a team environment
• PC literate, including Microsoft Office products
• Strong analytical and interpretive skills
• Excellent oral and written communication, including persuasive writing skills
• Ability to meet or exceed Performance Competencies
• Strong interpersonal skills

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $53,973 to $75,562/USD annual salary. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.