Medicare specialist job description

Job Functions, Duties, Responsibilities and Position Qualifications:

The A/R Follow Up Specialist is responsible for the management of Medicare accounts through written or verbal direction from patients, aged trial balance reports and Medicare rejection reports for the accurate and timely filing of claims for maximum reimbursement. A/R Follow Up Specialists will have the ability to provide support to other Accounts Receivable departments, as needed. All staff must adhere to all department policies and procedures.

Job Responsibilities:

Essential Functions:

* Customer service duties include answering telephones politely and confidently for patients and others regarding billing inquiries and resolving billing issues.
* Act as a resource regarding Medicare compliance guidelines.
* Accurately enter information provided by various sources to correct claims in regards to CPT and ICD-10 codes and send out results in a timely manner to Medicare.
* Must be able to interpret and communicate Medicare Explanation of Benefits.
* Must be able to make calls to insurance carrier to obtain elaborated description of the claim denials.
* Must be able to interpret and communicate Explanation of Medicare Advantage Benefits.
* Audits accounts showing Medicare denials to resolve balances.
* Resolve invoice issues from outside laboratories for Medicare patients.
* Communicate with Team Lead and/or A/R Supervisor as needed.
* Strong data entry skills, with the ability to meet production guidelines as set by A/R department policy.
* Ability to stay work focused and performs job duties efficiently and accurately.
* Employee must comply with Sonic Healthcare USA's compliance policies and procedures.
* Duties include but are not limited to the above mentioned responsibilities.
* Perform other duties as assigned.

Skills:

* Knowledge of computer technology and terminology
* Ability to type and demonstrate10 key proficiency
* Perform duties in a timely and accurate manner
* Maintain confidentiality of information
* Ability to communicate effectively at all levels within the company, with patients and physician office staff
* Possess effective work habits and ability to build/maintain work relationships
* Ability to read and comprehend English
* Ability to work under deadlines

Job Qualifications:

Required:

* High School diploma or GED
* Typing (min 35 wpm) and 10 Key

Preferred

* 2 years' experience in standard Medicare or related HMO plans
* Experience with medical coding, private insurance, laboratory and/or medical billing
* Customer service experience
* Bilingual speaking skills/Spanish
* Experience in multitasking environment

Scheduled Weekly Hours:

40

Work Shift:

1st Shift (United States of America)

Company:

Sonic Healthcare USA, Inc

Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

The Enroller is accountable for facilitating targeted enrollment activities to help increase membership and build support for Kaiser Permanente. No benefits will be provided. All incumbents will be hired as On-Call / Per-Diem.
Essential Responsibilities:

+ Conduct purchaser stand-up meetings and presentations for any of the products offered by KP. Responds to questions.

+ Facilitate enrollment activities by representing Kaiser Permanente, and transporting enrollment materials and promotional items.

+ Track and monitor open enrollment activities.

+ Engage local/branch account contacts to ensure understanding of and commitment to KP.

+ Communicate purchaser issues regarding accounts and book of business accurately and within specified timeframe.

+ Identify and report purchaser trends to internal stakeholders.

+ Accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.

Basic Qualifications:

Experience

+ N/A

Education

+ Bachelor's degree or currently enrolled in a degree program OR four (4) years of experience in a directly related field.

+ High school diploma OR General Education Development (GED) required.

License, Certification, Registration

+ N/A

Additional Requirements:

+ Excellent customer service and face-to-face presentation skills required.

+ Required Competencies: business ethics, initiative, interpersonal communication, results driven, presentation skills,change adaptability.

+ Strong knowledge of KP organization, values, and products required.

+ Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

+ Three (3) years of experience in sales and marketing in health care, some of which should be in Enrollment.

+ Three (3) years of experience in enrollment.

+ Bi-lingual language knowledge.

+ CA Accident and Health Insurance license.

COMPANY: KAISER

TITLE: Medicare Enroller - On Call Bilingual Spanish

LOCATION: San Diego, California

REQNUMBER: 1085944

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.