Medicare Specialist (Remote)
Company: Sedgwick
Location: Tallahassee
Posted on: May 28, 2023
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Job Description:
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
It's an opportunity to do something meaningful, each and every day.
It's having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a
positive impact on the world through the people and organizations
we serve. If you are someone who is driven to make a difference,
who enjoys a challenge and above all, if you're someone who cares,
there's a place for you here. Join us and contribute to Sedgwick
being a great place to work.
Great Place to Work -
Most Loved Workplace -
Forbes Best-in-State Employer
Medicare Specialist (Remote)
PRIMARY PURPOSE : To coordinate, analyze and facilitate Medicare
Compliance and Medicare Set-Aside (MSA) functions within the
assigned team.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Compiles, reviews and analyzes claim files and/or management
reports.
Compiles and organizes medical records; distributes to Medicare
Compliance nurses for analysis; and provides guidance and advice on
processing claims based on nurses' analysis.
Requests rated-ages; tracks files/requests/submissions through
Centers for Medicare and Medicaid Services (CMS) processes; and
creates documentation as required.
Communicates and advises appropriate internal and external
stakeholders on Medicare Compliance and Medicare Set-Aside (MSA)
matters including, but not limited to, lien negotiation efforts,
MSA submissions and/or general information.
Maintains thorough understanding of service and products offered by
Medicare Compliance department.
Analyzes and processes complex claims by investigating and
gathering information to determine the exposure on the claims;
manages claims through well-developed action plan to an appropriate
and timely resolution.
Analyzes lien notices for accuracy, communicates with the CMS to
efficiently facilitate lien resolutions on claims and/or prepare
MSA submissions in accordance with submission guidelines from CMS
as assigned.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university
preferred.
Experience
Four (4) years claims management experience or equivalent
combination of experience and education required. Experience with
Medicare issues preferred.
Skills & Knowledge
Thorough knowledge of claims management
Excellent oral and written communication, including persuasive
writing skills
PC literate, including Microsoft Office products
Strong analytical and interpretive skills
Strong organizational skills
Strong interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to
reasonable accommodations.
Mental : Clear and conceptual thinking ability; excellent judgment,
troubleshooting, problem solving, analysis, and discretion; ability
to handle work-related stress; ability to handle multiple
priorities simultaneously; and ability to meet deadlines
Physical : Computer keyboarding, travel as required
Auditory/Visual : Hearing, vision and talking
As required by law, Sedgwick provides a reasonable range of
compensation for roles that may be hired in jurisdictions requiring
pay transparency in job postings. Actual compensation is influenced
by a wide range of factors including but not limited to skill set,
level of experience, and cost of specific location. For the
jurisdiction noted in this job posting only, the range of starting
pay for this role is $53,973 to $75,562/USD annual salary. A
comprehensive benefits package is offered including but not limited
to, medical, dental, vision, 401k and matching, PTO, disability and
life insurance, employee assistance, flexible spending or health
savings account, and other additional voluntary benefits.
The statements contained in this document are intended to describe
the general nature and level of work being performed by a colleague
assigned to this description. They are not intended to constitute a
comprehensive list of functions, duties, or local variances.
Management retains the discretion to add or to change the duties of
the position at any time.
#LI-REMOTE #LI-Medicare #LI-RS1
Sedgwick is an Equal Opportunity Employer and a Drug-Free
Workplace.
If you're excited about this role but your experience doesn't align
perfectly with every qualification in the job description, consider
applying for it anyway! Sedgwick is building a diverse, equitable,
and inclusive workplace and recognizes that each person possesses a
unique combination of skills, knowledge, and experience. You may be
just the right candidate for this or other roles.
Taking care of people is at the heart of everything we do. Caring
counts
Sedgwick is a leading global provider of technology-enabled risk,
benefits and integrated business solutions. Every day, in every
time zone, the most well-known and respected organizations place
their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing - one where caring
counts. Watch this video to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Tallahassee , Medicare Specialist (Remote), Other , Tallahassee, Florida
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