Medicare Specialist Virtual Jobs

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.

·Strong interpersonal, time management and organizational skills.

·Effective multi-tasking skills in a high-volume environment.

·Excellent written and verbal communication skills.

·Certification as a MSCC, CMSP, CLCP or CNLCP, preferred.

·Understand and apply evidence based medical treatment guidelines, and/or CMS guidelines to future care recommendations.

·Identify and outline Medicare and Non-Medicare covered treatment.

Excellent interpersonal skills and time management

Other duties and responsibilities as assigned

Qualifications:** - High school diploma or equivalent

Previous medical billing experience preferred

Essential Functions:** - Responsible for claim status checks as needed to ensure proper resolution

Initiating contact with insurance providers as needed

*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.

Experience working with business partners and product managers

Stay up to date on industry trends and technologies to enhance the virtual client experience

Attention to detail and problem-solving skills

4+ years of previous banking and teller experience

3+ years of proven sales experience

Disability Accommodation Statement: Employer provides reasonable accommodations to individuals with disabilities in the employment application process.

Keep alert to competitive products and marketing practices, and to keep management informed concerning them

Understand the covered benefits, non-covered benefits, exclusions and exemptions

Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product

Disclosures and provisions of the Advantage Medicare product

Develop a presence in the local community to help generate enrollments

Conduct home visits and personalized appointments as needed to complete the enrollment process

Keep alert to competitive products and marketing practices, and to keep management informed concerning them

Understand the covered benefits, non-covered benefits, exclusions and exemptions

Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product

Disclosures and provisions of the Advantage Medicare product

Develop a presence in the local community to help generate enrollments

Conduct home visits and personalized appointments as needed to complete the enrollment process

Strong technology skills using MS Office tools and client work order management software

Must possess strong time management skills, the ability to prioritize and work with a sense of urgency at all times

Prior residential/multifamily maintenance experience preferred

Problem-solving experience is a plus.

Excellent written and verbal communication abilities in a team environment

Strong typing and computer skills

Cross train in multiple areas and perform all other duties as assigned by management.

Time management and reliable attendance

Bachelor's degree preferred, or equivalent combination of education, training, and experience

Investigate and coordinate insurance benefits for insurance claims across multiple service lines.

Review and understand eligibility of benefits.

Demonstrate excellent customer service, communication skills, creativity, patience, and flexibility.

Income protection benefits: life insurance, Short- and long-term disability programs;

Additional voluntary benefits available; and

The essential functions listed represent the major duties of this role, additional duties may be assigned.

Develop and maintain a Medicare Sales Operations Integrity plan and KPIs that align to CMS marketing and sales related practices

Work closely with sales channel leaders and their teams to collect and share data that strengthens compliant outcomes

Collect, analyze and report on data from various Sales activities to identify potential risk

Experience marketing to a culturally diverse target population required

Excellent verbal and written communication skills, including the ability to speak in front of large groups required

Coordinates home nursing assessment visits, when appropriate, to ensure successful enrollment into the program.

Educates VNS Health Plans MA and/or MLTC members on MAP and conducts telephonic enrollments into the product.

Performs retention efforts developed by VNS Health leadership to reduce member turnover.

Educates consumers who contact VNS Health Plans via website about VNS Health Plans Medicare products.

Ability to pass licensing exam and Carrier certifications annually and maintain good standing

Actively manage all assigned appointments to ensure all retirees needs are met on a timely basis

Deliver a consistently positive customer experience in a highly ethical and professional manner

Expiry Date: 04 September 2023

Meet and/or exceed monthly sales goals and service levels

Handle inbound service calls by providing accurate and complete information via researching/selling/locating licensed agent

Handle all correspondence via mail, email and any necessary refunds; perform other duties as assigned by management

Strong computer skills. Basic understanding of MS Outlook, Word and Excel.

Experience in an environment where calls were monitored and scored as well as metrics applied to individual performance is helpful.

Excellent communication skills, both written and verbal. Able to present information and solutions in a professional and courteous manner.

Shift M-F 830am-5pm EST. Fully Remote. Work from the comfort of your home.

Review claims that have been put on hold, working to identify causes and address issues causing them to remain on hold

Communicate professionally with clients and colleagues

Engage with clients and ask questions to determine their wants, needs, preferences, and expectations

Research, plan, and organize itineraries based on client needs

Create quotes, itineraries, and invoices

Stay up to date with industry news, changes, restrictions and best practices

Must be 18+ and a resident of the United States

Communicate professionally with clients and colleagues

Engage with clients and ask questions to determine their wants, needs, preferences, and expectations

Research, plan, and organize itineraries based on client needs

Create quotes, itineraries, and invoices

Stay up to date with industry news, changes, restrictions and best practices

Must be 18+ and a resident of the United States

Communicate professionally with clients and colleagues

Engage with clients and ask questions to determine their wants, needs, preferences, and expectations

Research, plan, and organize itineraries based on client needs

Create quotes, itineraries, and invoices

Stay up to date with industry news, changes, restrictions and best practices

Must be 18+ and a resident of the United States

Communicate professionally with clients and colleagues

Engage with clients and ask questions to determine their wants, needs, preferences, and expectations

Research, plan, and organize itineraries based on client needs

Create quotes, itineraries, and invoices

Stay up to date with industry news, changes, restrictions and best practices

Must be 18+ and a resident of the United States

Communicate professionally with clients and colleagues

Engage with clients and ask questions to determine their wants, needs, preferences, and expectations

Research, plan, and organize itineraries based on client needs

Create quotes, itineraries, and invoices

Stay up to date with industry news, changes, restrictions and best practices

Must be 18+ and a resident of the United States

Communicate professionally with clients and colleagues

Engage with clients and ask questions to determine their wants, needs, preferences, and expectations

Research, plan, and organize itineraries based on client needs

Create quotes, itineraries, and invoices

Stay up to date with industry news, changes, restrictions and best practices

Must be 18+ and a resident of the United States

Assist in developing, organizing, and updating training manuals, multimedia visual aids, and other educational materials.

Evaluate the impact of each learning experience in order to drive continuous improvement.

Experience training in a fast pace virtual training environment

Experience with go-lives and go-live support in the healthcare industry

Conduct virtual trainings to healthcare individuals

Develop content for your own virtual trainings