The Medicare Specialist is responsible for managing and processing all Medicare claim denials in compliance with state and federal guidelines. The Medicare specialist works closely with department management to maintain efficient billing and reimbursement of all Medicare claims. Position will also be responsible for reporting denials trends on a monthly basis and identifying individuals in the department responsible for denials. This position will be responsible for staying up to date with Medicare updates, available Medicare training and communicate this training with department manager. Responsible for accurate sending and receiving of claim submissions. Work with cash posting to work and resolve any zero payments within 24 hours of the posted payments. Position will follow up all Medicare A/R on outstanding claims, oversee the Medicare aging and denial workflows to ensure timely claim processing and follow-up. Analyze and resolve issues with Medicare payors and report findings and solutions to billing manager in a timely manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Perform monthly report of all Medicare denials and discuss findings with Billing Management and VP of Healthcare Integration.
2. Monitor changes in Medicare regulations and report changes and updates to department manager.
3. Ensure compliance with Medicare with billing and coding compliance.
4. Investigate and resolve any Medicare denials or billing discrepancies.
5. Review and work all Medicare refunds sent to you by obtaining appropriate documentation, then determining the correct means of issuing the refund, either electronically or by creating a check request prior to sending to accounts payable. 
6. Meet with department management bi-monthly to review current Medicare aging and review current Medicare A/R.
7. Other duties as assigned.

Education and Training Requirements:

• High School diploma required; some college preferred
• 5 years of ambulance billing 
• Strong computer skills
• Strong verbal and written communication and customer service skills
• Strong attention to detail and accuracy in data entry
• Ability to decipher information from the CMS coding guidelines and apply the accurate information to patient information