Medicare Ops Specialist Jobs in Arkansas

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Participates in regular member benefits training with health plan, including the member advocate/engagement role.

2 years experience in customer service, consumer advocacy, and/or health care systems.

Experience conducting intake, interviews, and/or research of consumer or provider issues.

Basic understanding of managed healthcare systems and Medicare.

Log all contacts in a database.

Accurately assess current district requirements for rostering and integration understanding their capabilities and offer solutions for basic integration requests.

Location: In this US-based position your location will be remote, preferably in Phoenix, AZ.

Writing skills to create detailed and accurate documentation of all customer interactions in the appropriate business tool (NetSuite, Jira, ZenDesk, etc.).

Basic experience with Salesforce or other CRM, with ability to search, add data, and retrieve reports.

Experience working with School District Staff and Administrators in a K-12 environment.

Outstanding problem-solving capability and critical thinking skills.

• Escalate appropriate coding audit issues to management as required

• Strong organizational skills; ability to time manage effectively

o 2 years’ experience in managed healthcare environment related to claims and/or coding audits

o Significant HCC experience (including knowledge of HCC mapping and hierarchy)

• Knowledgeable of coding/auditing claims for Medicare and Medicaid plans

• Extensive knowledge of ICD-9 & ICD-10 diagnostic coding and auditing

Thorough knowledge of claims management

Compiles, reviews and analyzes claim files and/or management reports.

Maintains thorough understanding of service and products offered by Medicare Compliance department.

Excellent oral and written communication, including persuasive writing skills

Strong analytical and interpretive skills

Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.

Thorough knowledge of claims management

Compiles, reviews and analyzes claim files and/or management reports.

Maintains thorough understanding of service and products offered by Medicare Compliance department.

Excellent oral and written communication, including persuasive writing skills

Strong analytical and interpretive skills

Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.