Job description
Position Summary
The Medicare Specialist is the internal resource responsible for compiling, reviewing and analyzing Medicare cases, claims and/or appeals. This role will provide decision support and serve as a liaison between physicians, product specialists, plans and patients to ensure the integrity of all cases. Identifies trends, complies with revised department procedures, and collaborates to ensure the best corporate policy and procedures for Medicare cases. Ensures timely, accurate and compliant processing for member and provider satisfaction.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
- Work closely with physicians, product specialists and patients to obtain medical record documentation to meet Medicare policy criteria
- Cover for other team members in their absences. This includes benefits checks, reviewing notes, creating documents, provider follow ups, and Medicare appeals
- Review documentation and accurately determine that they meet Medicare and BioTAB’s requirements
- Assist in training new members of the Medicare Team
- Develop and cultivate positive and professional relationships with stakeholders
- Researches and monitors issues related to trends that generate cases. Recommends revisions to Revenue Cycle Manager
- Ensure adherence with federal regulatory timeframes for handling cases including acknowledging cases, resolving cases, monitoring effectuation of resolution, completing resolution letters and communicating with members and providers within required time frames
- Work collaboratively within the team and with other departments
Comply with all HIPAA and privacy regulations- Adhere to laws and best practices in regards to dealing with patients and patient data
- Perform other job-related duties as assigned
Minimum Qualifications (Knowledge, Skills, and Abilities)
- High School Diploma or GED required
- Experience with Medicare, preferably with DME, minimum 1 year required
- Understanding of Medicare methodologies (coding, coverage, criteria, payments)
- Able to work collaboratively and cross-functionally with other departments to facilitate appropriate resolutions
- Excellent problem solving and analytical skills, required
- Ability to think and work effectively under pressure and accurately prioritize
- Must have good computer skills, experience with Microsoft Office, required
- Able to communicate clearly, orally and in written
- Able to work effectively with a wide range of people
- Time management skills
- Excellent organizational skills and attention to detail
Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
- Must be able to work onsite at our corporate headquarters in Maryland Heights, MO
- Must be able to work in an office setting, use a computer, keyboard and mouse for the majority of the shift and be able to communicate on the telephone
- Must be able to work the scheduled 8 hour shift Monday-Friday
- Work from home is available at supervisors discretion and as business needs allow, in accordance with the BioTAB Work From Home Policy
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