Reference #: GUIDUS34511EXTERNALENUS10503
Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.
Benefits info:
Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
Short- and long-term disability benefits
401(k) plan with company match and immediate vesting
Free telehealth benefits
Free gym memberships
Employee Incentive Plan
Employee Assistance Program
Rewards and Recognition Programs
Paid Time Off and Paid Sick LeaveSUMMARY STATEMENT
Responds to Medicare Part A and/or B telephone and/or written inquiries from the Medicare provider community which includes billing offices, medical societies, provider consultants, Managed Care Organizations, attorneys, etc. regarding Medicare coverage guidelines and policies covering a wide range of topics to include provider enrollment, Medicare appeals, debt recovery, claim payment information, telephone reopening requests, prior authorizations, and general coverage for multiple provider specialties.ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
Customer Service: 50%
Engage in dialogue with all customers using a customer-friendly tone even when challenged with overly aggressive customers.
Respond to each customer's need and request and ensure each customer's encounter is positive and productive.
Use good verbal and written communication during each customer encounter and never use jargon and slang.
Embrace diverse backgrounds and understand the needs of those customers who may not have as extensive knowledge of Medicare rules and regulations. Tailor responses to ensure customers receive the maximum benefit when calling Medicare.
Research and Problem Identification: 25%
Access multiple systems to research customer problems and record inquiry types.
Research CMS and company websites to provide knowledge and education to customer on additional resources which can be used in the future.
Access the Interactive Voice Recognition (IVR) and Internet Portal systems as needed to help educate customers on self-service options that are available to them.
Problem solving and Analysis: 25%
Review claims processing systems to identify specific claim edits and audits applied on claims. Analyze claim edits and audits to determine reasons for claim denials.
Review debt recovery systems to troubleshoot reasons for pending accounts receivables and the generation of overpayment demand letters. Review and analyze data to determine reasons for overpayments.
Review local medical coverage and national medical coverage policies in order to troubleshoot reasons for claim denials and reductions.
Review other systems to address and determine resolution to other customer issues to include pending appeals, aged claims, and Medicare Secondary Payer.
Performs other duties as the supervisor may, from time to time, deem necessary.REQUIRED QUALIFICATIONS
High School Diploma or GED
1 year related work experience; this includes experience in call center, customer focus, or claims experience
Demonstrated internet and/or PC software navigation
Demonstrated strong problem solving and decision-making kills
Demonstrated good listening and strong verbal communication skillsPREFERRED QUALIFICATIONS
Post-secondary education/classwork
Experience in the insurance industry or medical coding or related work experienceThis opportunity is open to remote work in the following approved states: AL, AK, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require additional approval. In FL, PA, TX and WI, in-office and hybrid work may also be available.The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive."We are an Equal Opportunity Employer/Protected Veteran/Disabled"Novitas Solutions, Inc. is an Equal Opportunity Employer - Protected Veteran/Disabled
