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Medicare Specialist

DEPARTMENT

Billing

LOCATION

Somerville, Mass.

EDUCATION

High School or GED

EXPERIENCE

No Previous Experience

JOB DESCRIPTION

The Medicare Billing Specialist is responsible for handling all Medicare Part B and Rail Road Medicare payers Aging reports. Specialist will handle all incoming member and provider Part B correspondence, denials, appeals and grievances. MBS determines appropriate classification of each request, performs accurate data entry and conducts initial processing and assignment of requests. Initiates, reviews, retains and maintains all internal and external controlled documents, and inputs data into a computer processing system. Adheres to all regulatory requirements and operating procedures.

RESPONSIBILITIES

  • Responsible for intake of grievances/appeals received through customer call centers, mail, email and fax. Route misdirected information to correct staff for timely and appropriate action;
  • Handling and processing all correspondence such as but not limited to denials, appeals, ALJ’s in a timely manner;
  • Assists in gathering comprehensive documentation as needed from varied internal and external sources relevant to issue raised in grievance/appeal;
  • Conducts research by speaking with members and providers, reviewing member’s records and benefit plan and obtaining responses from various business areas
  • Assists team in billing/documenting/updating cases in tracking database and other member information, maintain accurate grievance/appeal records;
  • Demonstrates ability to identify complex information and deliver the information both verbally and written, in a professional, clear, concise and articulate manner;
  • Maintains filing system and ensure all files are stored timely and accurately both electronically and hard copy;
  • Requires excellent interpersonal skills in order to communicate and work with multiple constituents and be able to recognize sensitive issues and when to escalate to Management;
  • Must have a thorough understanding of health plan operations and business unit processes, work flows and system.

 

QUALIFICATIONS

Required

  • High School graduate/GED;
  • Medical coding training and experience;
  • Familiar with Medicare/CMS and Medicaid laws and billing.

 

Desired

  • Experience coding governmental payers;
  • Certified Ambulance Coder;
  • Ambulance Industry experience;
  • 3-5 years experience in billing.

 

The above are intended to describe the general nature and level of the work being performed by the person/people in this position. This is not an exhaustive list of all duties, responsibilities, knowledge, skills, and abilities associated with this position. Cataldo Ambulance is an Equal Opportunity / Affirmative Action Employer All qualified applicants will receive consideration for employment without regard to disability, race, color, veteran status, religion, sex, or national origin. Individuals with Disabilities and Veterans are encouraged to apply.

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