Medicare Part A Insurance Representative (Remote)

Medicare Part A Insurance Representative

Summary: The EBO Government Insurance Specialist is responsible for working with Medicare Part A to verify benefits to assist unit in resolving consumer account balances and working with consumers on behalf of our client as an extended business partner.

Essential Duties and Responsibilities:

• Review and identify inappropriate denials for immediate resolution.
• Knowledge of the appeals process relating to Medicaid/Medi-Cal accounts.
• Ability to identify incorrect payments (under-payment) from Government agencies.
• Maintain patient confidentiality when answering telephone inquiries from insurance companies about account status, balances, and total billed charges.
• Maintain familiarity with hospitals contractual agreements.
• Compliance with all billing policies as mandated by State and Federal Regulations.
• Ability to determine billable vs non-billable charges.
• Informs Director of any billing delays due to systems malfunction, coding, authorizations, etc.
• Must follow HIPPA guidelines.

Experience/Skills:

• Knowledge of the UB04 claims format
• Working Knowledge of DDE/eSolutions
• Knowledge of the billing codes relating to CPT/HCPCS, ICD9 codes
• Ability to determine billable vs non-billable charges
• Ability to identify duplicate charges
• Knowledge of Medicare deductibles and coinsurance

Compliance:

Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office

Excellent benefit package available including:

• Medical
• Dental
• Vision
• Short-term Disability
• Long-term Disability
• 401k
• Life insurance benefits
• PTO
• Paid Holidays

Equal Opportunity Employer. All qualified applicants will receive equal consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law.