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Medicare Specialist (Remote) Jobs
Company | Sedgwick |
Address | Delaware, United States |
Employment type | FULL_TIME |
Salary | |
Category | Insurance |
Expires | 2023-06-18 |
Posted at | 1 year ago |
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
- Compiles, reviews and analyzes claim files and/or management reports.
- Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses’ analysis.
- Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
- 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.
- Maintains thorough understanding of service and products offered by Medicare Compliance department.
- 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.
- 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.
- Performs other duties as assigned.
- Travels as required.
- Supports the organization's quality program(s).
- Excellent oral and written communication, including persuasive writing skills
- Strong organizational skills
- Strong interpersonal skills
- Ability to meet or exceed Performance Competencies
- PC literate, including Microsoft Office products
- Thorough knowledge of claims management
- Strong analytical and interpretive skills
- Ability to work in a team environment
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