What are the responsibilities and job description for the Medicare Claims Specialist position at Barrow Wise Consulting, LLC?
Medicare/Medicare Claims Processor
Are you a problem-solver with a passion for emerging technologies? Do you enjoy working in a dynamic and innovative environment? Barrow Wise Consulting, LLC is seeking a skilled Medicare/Medicare Claims Processor to join our team.
Key Responsibilities:
- Review and verify incoming claims for accuracy and completeness
- Enter claim data into the system and ensure all required fields are populated
- Verify patient eligibility for Medicare and Medicaid coverage
- Confirm services rendered are covered under the respective programs
- Assign diagnosis and procedure codes to claims
- Calculate reimbursement amounts based on fee schedules and program rules
- Process claims through automated systems
- Identify and resolve claim errors, discrepancies, or missing information
- Communicate with providers, patients, and stakeholders regarding claim status, denials, and appeals
- Collaborate with internal teams to address claim-related inquiries
- Assist in handling claim appeals, including gathering necessary documentation and submitting appeals to Medicare and Medicaid
- Track and monitor the progress of appeals
- Ensure compliance with federal and state regulations related to claims processing
- Maintain accurate records and documentation of claims activities
- Participate in quality control processes to prevent payment errors and fraud
- Identify trends or patterns in claims data for process improvement
Requirements:
- U.S. Citizenship
- Associate's Degree or Bachelor's degree
- 3 years of experience in healthcare claims processing, preferably with Medicare and Medicaid claims
- Knowledge and certification of ICD-10, CPT, and/or HCPCS coding
- Familiarity with claims adjudication software and electronic health records (EHR) systems
- Attention to detail and strong analytical abilities
- Excellent communication skills for interacting with providers and beneficiaries
- Ability to work independently and meet deadlines
- Understanding of healthcare billing and reimbursement processes
- Integrity and commitment to maintaining patient privacy
- Adaptability to changing regulations and guidelines
- Problem-solving mindset and customer service orientation
Barrow Wise Consulting, LLC offers a competitive compensation package, excellent benefits, and opportunities for growth and advancement in a diverse and ethical work environment. We are an equal-opportunity, drug-free employer committed to diversity in the workplace. Minority/Female/Disabled/Protected Veteran/LGBT are welcome to apply.
