[Hiring] Sr. Medicare Associate @Sedgwick

Role Description

To gather documentation required to complete Medicare Compliance referrals in a timely manner; to upload referrals to Medicare Compliance System (MCS); to review the pay histories and medical records for adequacy; and to resolve technically difficult record files.

• Reviews JURIS pay ledger as a guide to locate medical records needed for MCS assignment; analyzes additional records to determine if they are pertinent to Medicare Set Aside (MSA); and determines appropriate course of action.
• Pulls and sorts medical records required for complex Medicare Compliance referral from appropriate sources; identifies missing document/records; requests missing documentation from provider, examiner and/or defense counsel.
• Handles complex records issues by identifying and seeking out critical records to create a file that meets government requirements.
• Reviews and submits medical records to nurses to enable them to complete referral in a timely manner; uploads referrals and reports from claims system into MCS; ensures MCS is updated properly.
• Responds to questions from examiners about Medicare Compliance processes and products.
• Documents activity in MCS; communicates MCS action with examiner via JURIS notes.
• Creates daily reports to manage workload and monitors due dates.
• Communicates with examiners and defense counsel to resolve technically difficult issues related to obtaining medical records.
• Assists in training new departmental colleagues.
• Assists with special client projects as needed.

Qualifications

• Education & Licensing: High school diploma or GED required.
• Experience: One (1) year of general office experience required. Claims or medical records/billing industry experience preferred. Two (2) years of experience as Medicare Associate required.
• Skills: Excellent oral and written communication skills, PC literate, including Microsoft Office products, analytical and interpretive skills, and ability to meet or exceed Performance Competencies.
• Work environment requirements include:
• Physical: Computer keyboarding
• Auditory/visual: Hearing, vision and talking
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Requirements

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• 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 $20.00 per hour.

Benefits

• 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
• Other additional voluntary benefits