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Medicare specialist skills for your resume and career

Updated January 8, 2025
4 min read
Quoted experts
Li Zhang Ph.D.,
Li Zhang Ph.D.
Below we've compiled a list of the most critical medicare specialist skills. We ranked the top skills for medicare specialists based on the percentage of resumes they appeared on. For example, 8.9% of medicare specialist resumes contained customer service as a skill. Continue reading to find out what skills a medicare specialist needs to be successful in the workplace.

15 medicare specialist skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how medicare specialists use customer service:
  • Provided telephone customer service to clients including processing electronic payments and researching system generated statements.
  • Completed applications with customers over phone and provided customer service for questions.

2. Patients

Here's how medicare specialists use patients:
  • Handle and examine information needed from private medical records and personal information from patients and medical providers.
  • Educated patients without insurance regarding available options to offset hefty medical expenses.

3. Health Insurance

Here's how medicare specialists use health insurance:
  • Schedule sales events in compliance with CMS and health insurance carrier rules.
  • Assist consumers with completing their applications for health insurance.

4. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how medicare specialists use cms:
  • Interfaced with managed care organizations, CMS regional offices and Congressional offices regarding issues concerning members' Medicare payment records.
  • Exceeded all production and quality levels while adhering to strict guidelines established by CMS through excellent time management skills.

5. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how medicare specialists use cpt:
  • Worked daily, weekly & monthly reports, utilizing strict Medicare part A, HCFA & CPT guidelines.
  • Coded claims using the CPT and ICD-9-CM coding systems appropriate at the time.

6. Appeals

Here's how medicare specialists use appeals:
  • Prepared written and verbal communication to Administrative Law Judges, providers, vendors and beneficiaries regarding Reconsideration appeals.
  • Maintained appeal log in departmental database to expedite timely resolution of appeals.

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7. Inbound Calls

Here's how medicare specialists use inbound calls:
  • Answer inbound calls for existing and potential Medicare customers seeking assistance with prescription drug and medical claims.
  • Receive inbound calls from Medicare members; determine the reason for the call and resolve.

8. Medicare

Medicare is a federal government insurance program that offers health care coverage to people who are 65 and above. In some cases, younger people with disabilities whose status is identified by the SSA can also avail the insurance program. Medicare covers the health expenses of people who are not able to afford it plus it protects the payee from rising health care costs.

Here's how medicare specialists use medicare:
  • Facilitated follow-up on all denied claims, posted Medicare payments, and reviewed all documentation submitted electronically to Medicare.
  • Reviewed claims information such as diagnosis, medical reports and other documentation to determine Medicare's conditional payment.

9. Medicaid

Here's how medicare specialists use medicaid:
  • Billed medicaid/Medicare carrier by inputting billing information to database; initiating electronic transmissions.
  • Gathered medicaid billing information by reviewing patient hospital records; checking for completeness.

10. Medical Terminology

Here's how medicare specialists use medical terminology:
  • Correlate knowledge of general anatomy and medical terminology to perform coding and billing tasks.
  • Demonstrated strong understanding of medical terminology.

11. ICD-9

Here's how medicare specialists use icd-9:
  • Included knowledge of ICD-9 codes and state fee schedules/usual and customary.
  • Obtained accurate ICD-9 codes and processed completed CMN's.

12. Medical Billing

Here's how medicare specialists use medical billing:
  • Used Remedy and Virtual Manager and Ovation Programs for medical billing.
  • Assisted physician offices with medical billing and coding questions.

13. Federal Regulations

Federal regulations refer to the set of rules, both general and permanent that are published in the Federal Register by the agencies of the federal government and the executive departments. Federal regulations are the large body of rules that govern federal practice. Examples of these laws include taxes and financial regulation, discrimination law, wages law, and so on.

Here's how medicare specialists use federal regulations:
  • Better than 95% case resolution in compliance with FDA, state and federal regulations and protocols.
  • Act as subject matter expert for State and Federal regulations.

14. Insurance Carriers

Here's how medicare specialists use insurance carriers:
  • Researched, posted and applied refund checks received from the other insurance carriers, attorneys, beneficiaries and providers.
  • Make phone calls to other insurance carriers to verify information.

15. Outbound Calls

An outbound call is made by the call center representative to the customers on behalf of the company. Such calls help increase sales and generate revenue for the organization.

Here's how medicare specialists use outbound calls:
  • Answered inbound and outbound calls within the call center.
  • Handled 200+ inbound/ outbound calls a day.
top-skills

What skills help Medicare Specialists find jobs?

Tell us what job you are looking for, we’ll show you what skills employers want.

What skills stand out on medicare specialist resumes?

Li Zhang Ph.D.

Professor, St. Cloud State University

There aren't many universities/colleges that offer a degree in insurance. Having some insurance education, such as a degree, or a certificate, or just taking a few insurance classes, will be sure to make applicants stand out. For those with no insurance background, demonstrating strong transferable skills from previously studied areas to the insurance industry (such as communication skills, analytical skills), strong commitment, ethical and professional attitude will make the applicants very competitive.

What soft skills should all medicare specialists possess?

Li Zhang Ph.D.

Professor, St. Cloud State University

I'd say communication skills. Many positions in insurance need to interact with others. The ability to listen carefully and responding effectively, conveying thoughts/ideas fluently is very important. Also, communicating throng writing is also important (it could range from simply completing the paperwork accurately to preparing annual reports for supervisors)

What hard/technical skills are most important for medicare specialists?

Li Zhang Ph.D.

Professor, St. Cloud State University

It would be analytical skills and numerical skills, no matter if it's in underwriting, claims, actuarial, investment, sales, or other positions. For example, a successful salesperson should be able to efficiently analyze the client's information, assess the client's need, recommend the appropriate products, and convey product advantages and disadvantages clearly. Also, competent employees should be comfortable with working with numbers/graphs to communicate with clients or coworkers.
Do you want to know more?
Read more about what experts have to say about medicare specialist

List of medicare specialist skills to add to your resume

Medicare specialist skills

The most important skills for a medicare specialist resume and required skills for a medicare specialist to have include:

  • Customer Service
  • Patients
  • Health Insurance
  • CMS
  • CPT
  • Appeals
  • Inbound Calls
  • Medicare
  • Medicaid
  • Medical Terminology
  • ICD-9
  • Medical Billing
  • Federal Regulations
  • Insurance Carriers
  • Outbound Calls
  • Insurance Claims
  • Billing Issues
  • Open Enrollment
  • Medicare Advantage
  • Hippa
  • HIPAA
  • Durable Medical Equipment
  • A/R
  • Patient Accounts
  • Medicare Part D
  • EOB
  • DDE
  • HCPCS
  • Medical Necessity
  • Medical Claims
  • Hard Copy
  • Processing Claims
  • Health Plan
  • MSP
  • Telephone Inquiries
  • Insurance Verification
  • Customer Inquiries
  • Life Insurance
  • Medicare HMO
  • Resubmit Claims
  • Medical Documentation
  • B Claims
  • ALJ
  • PPO
  • Billing System
  • RTP

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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