Medicare and Commercial Account Specialist - Remote
|Company:||Convergent||Location:||Boca Raton, Florida, United States|
|Posted:||Tuesday, April 17, 2018|
Medicare Account Specialist - Government & Commercial Insurance Appeals and Reimbursement - REMOTE POSITION
Applicants must include salary requirements to be considered.
Convergent’s Boca Raton FL Insurance Department has an opening for a remote Account Specialist with expertise in Medicare and Commercial billing and reimbursement. Knowledge of Medicaid is a plus. This is an ideal opportunity for a healthcare professional looking for remote work. The successful candidate can work from anywhere in the country and report to our Boca Raton, FL offices.
Convergent employs a dedicated team of expert healthcare attorneys and Account Specialists who navigate the entanglements of the legal system to increase reimbursement rates for our client hospitals all over the country. We apply our advanced technology to calculate anticipated payment for claims in states with complex fee schedules, allowing us to accurately identify and appeal underpaid or denied claims. Our main goal is to assist hospital systems to strengthen their financial and clinical performance. We are also a leading provider of denial management, Workers' Compensation claims resolution, and appeals solutions.
Responsible for appealing Medicare denials, and possibly rebilling underpayments; turning them into payments and ensuring accurate reimbursement on all claims.
Follow up on outstanding claims and charges by contacting payers for status.
Account Specialists work a caseload of accounts and report directly to a Supervising Attorney or Supervisor.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform all duties satisfactorily in a remote setting. The requirements listed below are representative of the knowledge, skill and/or ability required.
- REQUIRED QUALIFICATIONS: Experience with Medicare, Commercial Payers as well as Medicaid affiliated products.
- Strong ability to calculate and analyze expected reimbursement of the claim based on Medicare and Commercial Payer reimbursement methodology to identify underpayments, line denials, etc.
- Knowledge of various healthcare plans:, Medicare, HMO, PPO, POS, Medicaid
- Understanding of portals and sites used for verification, appealing, coding guidelines & billing.
- Familiarity with CMS (Medicare & Medicaid) regulations & commercial payers.
- Knowledge and understanding of CPT & HCPCS coding language as well as ICD-9 & ICD-10 knowledge
- Knowledge and understanding of UB04 and EOBs/RAs
- Strong analytical, problem-solving, and conflict resolution skills
- Excellent oral and written communication skills
- Working knowledge of medical terminology and abbreviations, and healthcare nomenclature
- Maintain strictest confidentiality
- Medicare Revenue Cycle: 2-5 years
- Healthcare Revenue cycle: 2-5 years
- High School graduate or equivalent is required.
- Preferred: Associates or Bachelor’s Degree
Hiring is contingent upon successful background check and drug screening.
Compensation: negotiable based on experience
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