A Medicare Specialist is hired to handle various kinds of duties related to Medicare billing or enrolment. The most common roles and responsibilities listed on the Medicare Specialist Resume include the following – overseeing employees under Medicare department, determining payment eligibility, obtaining approvals for Medicare processes, ensuring adhere with federal laws; handling Medicare billing, inquiry handling, coding, and compliance. Other tasks may include resolving billing issues, checking daily vouchers, and providing training to new Medicare employees.
A professional resume for this position lists skills and abilities like – healthcare claims auditing and quality assurance skills, a thorough knowledge of Medicare regulations, coding, billing, quality-management forms, requirements and processes; ability to use relevant software, and proficiency with health care billings. While a high school diploma or its equivalent is considered mandatory for entry-level positions, employers want higher qualifications for advanced positions.
Summary : Motivated leader with strong organizational and prioritization abilities. Accomplished, energetic team player that is dependable, a self-starter with a concrete history of achievement in membership services.
Audited Medicare UB92 and processed spreadsheets for eight nursing home Checked and coded invoices for payment.
Analyzed and processed rejected claims by investigating and gathering information to determine the error on the claims.
Assessed & resolved claims within evaluation Negotiates settlement of claims up to designated authority level and makes claim paid.
Calculated and assigned timely & appropriate reserves to claims and continues and continues to monitor reserve adequacy throughout the life of the claim.
Handled all Medicare billing and collections transactions and communicated with personnel at various local offices Provided exceptional customer service by answering questions, explaining services, and ensuring total satisfaction with the handling of each transaction.
Handled appeals for claims reprocessing using several online resources and systems, maintain government compliance, manage and screen cases, coordinate with other departments, and contact customers for necessary expedited document processing.
Worked in the Medicare department and responsible for reviewing and evaluating required documentation sent by doctors to submit an accurate, legal and ethical claim to Medicare and secondary insurers.
Shipped out transcutaneous electrical nerve stimulation units (TENS) to patients home or clinics after reviewing medical records looking for uncovered ICD-9 codes.
Experience
10+ Years
Level
Senior
Education
Medical Assistant
Sr. Medicare Specialist Resume
Summary : To pursue a challenging career with an exceptional healthcare organization that will give an opportunity to contribute skills and abilities.
Skills : Took informatics class, proficient in all Microsoft applications, Management, broadcasting ability,.
Description :
Followed-up on calls, written correspondence and any other service requests.
Managed in-bound calls for patients who need oxygen refills or other relevant equipment and requests.
Assisted the Intake department for order processing.
Worked with internal and external customers investigating and resolving problems as necessary.
Responded to customer questions concerning a variety of Univita products and services and assist with difficult callers when necessary.
Verified, created and billed Medicare claims for family owned medical/DME pharmacy using TIMS system; work denials off eob's and submit appeals for claims sent 6-12 months prior to arrival.
Performed all components of Medicare Billing including working RTP's (Returned to Provider) claims, Medicare report, Tracking report etc.
Experience
10+ Years
Level
Senior
Education
General
Jr. Medicare Specialist Resume
Objective : Highly effective customer service professional with excellent written and verbal communication skills, demonstrated expertise with training and technical writing, problem solving, and increasing customer retention.
Addressed all issues and concerns of the members in a professional manner.
Provided guidance during open enrollment while providing solutions to inquiries regarding benefit options.
Assisted associates in negotiating the waters of the health care system including but not limited to providing assistance in resolving complex claims issues as well as providing guidance to members that appear to be symptomatic so that they can obtain the medical attention that is required.
Answered questions as they related to their Benefit Plans while explaining to the individual processes instituted by their employers.
Assisted associates that have become Medicare eligible with the appropriate next steps to be taken in their enrollment while detailing their options for Medicare and supplemental products.
Placed outbound calls to providers, insurance carriers and billing agencies to intercede on the member's behalf for issues that could not be resolved during the initial call.
Utilized in a lead capacity to assist in the mentorship of new hires once they have completed initial training.
Experience
2-5 Years
Level
Junior
Education
Computer Technology
Medicare Specialist III Resume
Objective : Extensive knowledge acquired through the last 20 years of experience in the medical/clerical/retail field along with coding/billing certificate if applicable.
Skills : Microsoft Office, Public Speaking, Sales, Management.
Description :
Ability to independently manage a work queue consisting of correspondence from employers and Group Health Plans appealing Medicare's assertion of improper coordination of benefits.
Used of critical reading skills to determine the nature of appeals and correspondence by employers and Group Health Plans; follow Standard Operating Procedures (SOPs) to perform next steps.
Wrote Standard Operating Procedures (SOPs) for training of personnel.
Initiated a demand process with insurance companies including evaluation of beneficiary information and coordination of benefit information.
Tracked correspondence through the demand process to ensure a timely response within service level agreements.
Provided accurate and timely responses to queries.
Escalated queries that are not routine or have special circumstances to supervisors in alignment with prescribed processes.
Index scanned in images from OnBase to corresponding case in CAS making sure that the documentation, HICN and beneficiary information is correct to achieve optimal indexing for caseworkers.
Experience
2-5 Years
Level
Executive
Education
Diploma
Medicare Specialist II Resume
Objective : Motivated leader with strong organizational and prioritization abilities. Accomplished, energetic team player that is dependable, a self-starter with a concrete history of achievement in membership services. Areas of expertise include billing, customer service and communication.
Skills : Medical Assistant, Medical Tech.
Description :
Files secondary Insurance claims on all Medicare and Medicare Advantage Plan claims on a daily basis.
Updates, corrects and adds any omitted insurance and MSP information as needed in the Alternative system to ensure appropriate party is billed.
Payment auditing, refunds, adjustments, correspondence and telephone calls.
Works closely with Hospital registration, medical records, case management and ancillary departments for accurate billing information.
Performs work as scheduled, prioritizing as required for maximizing cash flow with ability to multi-task and keep work organized.
Ensures positive customer relations by providing prompt answers and keeping commitments.
Contacts Patients, Attorneys, Businesses for premises information not received at time of registration/admission.
Receives and replies to emails received daily from all areas at PFS and hospital staff requesting help to resolve concerns from billing to refund.
Experience
2-5 Years
Level
Junior
Education
Diploma
Medicare Specialist I Resume
Objective : Highly effective Medical professional with excellent written and verbal communication skills, demonstrated expertise with training and technical writing, problem solving, and increasing customer retention.
Skills : Nurse Tech, Medical Rep.
Description :
Consistently increased cash collections for high reimbursement daily.
Effectively reduced aged accounts 30-120 days to zero balances.
Interacted daily with Coding department regarding coding issues.
Reviewed daily correspondence to determine proper handling.
Verified Insurance eligibility through HDX, Medicare Common Working File, and Blue Cross Blue Shield and Medical Assistance EVS system.
Responsible for keying claims in the (DDE) Direct Data Entry system as well as make adjustments through the Fiscal Intermediary Shared System.
Prepared claims to be filed electronically, Posting credits and denials-Medicare Remittance Advices.
Related with facilities under SNF billing, Customer Relations, Software knowledge-Amazon/Sweet Soft, Excel.
Experience
2-5 Years
Level
Junior
Education
Diploma In Certification
Medicare Specialist/Supervisor Resume
Summary : Medicaid Specialist will be responsible for advanced technical work essential to maintaining the daily operations of the Pharmacy Program.
Skills : Medical Analyst, Medical Supervisor.
Description :
Performed billing and electronic transmission of claims.
Submited corrections for previously transmitted claims via Envoy/Emdeon.
Handled electronic postings of Medicare and other commercial carrier payments.
Submited initial billing to applicable third party carrier(s).
Verified claim status for previously submitted claims to Medicare via the IVR system.
Followed through with Medicare on Reviews, Appeals and Telephone Hearings processes mandated by the carrier.
Updated billing personnel on latest LMRP'S and coding issues for related procedure and diagnosis including but not limited to non-chemo and chemo drugs to ensure reimbursements are handled correctly.
Processed consolidated billing issues with applicable SNF's administrators in addition to successfully negotiating applicable payments for rendered services.
Experience
10+ Years
Level
Senior
Education
Medical
Medicare Specialist/Representative Resume
Summary : Seeking a position as a Medicare Specialist helping every customer's needs by providing excellent customer service.
Skills : Medical Executive, Medical Tech.
Description :
Responsible for all Medicare secondary accounts and for billing all Medicare HMO's.
Worked numerous reports to stay current on all billing and to find any accounts that had not been considered or billed.
Responsible for all Medicaid accounts as well as Medicare accounts while new Medicaid representative was hired and fully had her trained.
Investigated incorrect billings due to charges or credits on customers' accounts and took necessary steps to correct.
Interviewed customers and others in person and by telephone to answer inquiries and complaints pertaining to bills, customer deposits and accounts.
Trained new employees for other positions in the office along with training employees in the admissions area.
Experience
10+ Years
Level
Senior
Education
Medical
Medicare Specialist/Analyst Resume
Summary : To employee extensive business savvy, leadership skills, superior customer service abilities and interpersonal skills in a professional work environment.
Skills : Nurse Tech, Medical Supervisor.
Description :
Responsible for providing quality customer service and product assistance to the Company's Medicare client base.
Responsible for compiling, reviewing and evaluating required documentation to submit an accurate, legal and ethical claim to Medicare.
Take customer calls regarding questions about Medicare and their Empi devices.
Larned the position very quickly and also learned the function of another department and was able to assist them in getting caught up.
Skills Used Customer service skills including phone calls and emails as well as internal communication with c-workers.
Learned the position quickly and was able to be of help to co-workers who were behind on their work.
Learned new computer programs quickly and became efficient on them.
Experience
10+ Years
Level
Senior
Education
Medical Administration
Medicare Specialist Resume
Objective : Currently seeking a Medicare Specialist position that will allow to provide exceptional patient care as well aide in growth in the healthcare field.
Applied Payments to patient accounts without error.
Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts, reviewed billing edits and provided insurance with corrected information.
Ensured all billing is billed out in timely accurate time period.
Managed the accurate and timely processing of Medicare claims monthly with various issues.
Responsible for training of next-generation technologies Super User for Cerner conversion.
Trained users in Admissions and Patient Financial Services.
Served as the primary "go-to" troubleshooter on this new system.
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