A Medicare Specialist is hired to handle various kinds of duties related to Medicare billing or enrolment. The most common roles and responsibilities listed on the Medicare Specialist Resume include the following – overseeing employees under Medicare department, determining payment eligibility, obtaining approvals for Medicare processes, ensuring adhere with federal laws; handling Medicare billing, inquiry handling, coding, and compliance. Other tasks may include resolving billing issues, checking daily vouchers, and providing training to new Medicare employees.
A professional resume for this position lists skills and abilities like – healthcare claims auditing and quality assurance skills, a thorough knowledge of Medicare regulations, coding, billing, quality-management forms, requirements and processes; ability to use relevant software, and proficiency with health care billings. While a high school diploma or its equivalent is considered mandatory for entry-level positions, employers want higher qualifications for advanced positions.
Objective : Dedicated Medicare Specialist with two years of hands-on experience in claims processing, billing, and customer service. Proven ability to analyze and resolve complex claims issues while ensuring compliance with federal regulations. Committed to enhancing patient experiences by providing clear guidance and support throughout the enrollment process.
Audited Medicare UB92 and processed spreadsheets for eight nursing homes, ensuring accurate billing and compliance.
Analyzed and resolved rejected claims by investigating errors and gathering necessary information.
Assessed and negotiated settlements for claims within designated authority, ensuring timely payments.
Calculated and assigned appropriate reserves to claims, monitoring adequacy throughout their lifecycle.
Managed all Medicare billing and collections, providing exceptional customer service to resolve inquiries.
Handled appeals for claims reprocessing, maintaining compliance and coordination with various departments.
Reviewed documentation from doctors to ensure accurate and ethical claims submission to Medicare and secondary insurers.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in HA
Lead Medicare Specialist Resume
Headline : Accomplished Lead Medicare Specialist with 7 years of comprehensive experience in claims processing, billing, and compliance management. Expert in navigating complex regulations and enhancing patient satisfaction through effective communication and support. Proven track record of optimizing billing processes and resolving claims disputes to ensure timely reimbursements.
Managed inbound calls and service requests, ensuring prompt and accurate responses to patient inquiries.
Coordinated with the Intake department to process orders efficiently and effectively.
Investigated and resolved complex issues for internal and external customers, maintaining high levels of satisfaction.
Verified and processed Medicare claims using the TIMS system, addressing denials and submitting appeals where necessary.
Executed all aspects of Medicare billing, including managing Returned to Provider claims and tracking reports.
Provided guidance to patients regarding product offerings and complex billing inquiries.
Maintained comprehensive records of all claims and correspondence to support accurate reporting.
Experience
5-7 Years
Level
Senior
Education
B.S. Health Admin.
Medicare Specialist Resume
Objective : Enthusiastic Medicare Specialist with two years of experience in claims processing and member support. Adept at navigating complex healthcare regulations to resolve claims and enhance patient satisfaction. Passionate about guiding clients through the Medicare enrollment process and ensuring compliance with all regulations.
Resolved member inquiries and issues with professionalism, enhancing overall member satisfaction.
Guided clients through the open enrollment process, clarifying benefit options and addressing questions.
Assisted team members in navigating the healthcare system to solve complex claims issues.
Explained benefit plans and employer processes to members, ensuring clear understanding.
Supported associates transitioning to Medicare with detailed guidance on enrollment and product options.
Facilitated communication with providers and insurers to resolve outstanding claims issues.
Led training initiatives for new hires, fostering a collaborative and informed team environment.
Experience
0-2 Years
Level
Junior
Education
B.S. in HA
Senior Medicare Specialist Resume
Summary : Accomplished Senior Medicare Specialist with over 10 years of robust experience in claims management and regulatory compliance. Demonstrated expertise in optimizing processes, enhancing patient satisfaction, and navigating complex Medicare regulations. Passionate about delivering exceptional service and support throughout the enrollment process and resolving claims efficiently.
Skills : Billing And Coding, Customer Service Skills, Data Analysis Abilities, Problem-solving Skills, Attention To Detail, Communication Skills
Description :
Managed a diverse portfolio of Medicare claims, ensuring compliance with federal regulations and timely processing.
Utilized critical analysis skills to assess complex appeals and correspondence from employers and Group Health Plans.
Authored Standard Operating Procedures (SOPs) for staff training, enhancing operational efficiency.
Initiated and monitored demand processes with insurance companies, ensuring accurate beneficiary information.
Tracked correspondence through various processes, consistently meeting service level agreements.
Provided prompt and accurate responses to inquiries, escalating complex cases as needed.
Ensured accurate indexing of scanned documents to facilitate optimal case management.
Experience
7-10 Years
Level
Management
Education
B.S. in HA
Medicare Specialist Resume
Objective : Accomplished Medicare Specialist with 5 years of extensive experience in claims processing, billing, and regulatory compliance. Skilled in analyzing complex claims issues and ensuring adherence to Medicare guidelines. Passionate about improving patient outcomes through effective communication and support during the enrollment process.
Files secondary insurance claims for Medicare and Medicare Advantage plans daily.
Updates and corrects insurance and MSP information in the system to ensure accurate billing.
Conducts payment audits, processes refunds, and manages adjustments and correspondence.
Assisted clients in understanding Medicare benefits and enrollment processes.
Prioritizes workload effectively to maximize cash flow while maintaining organization.
Ensures excellent customer relations by providing prompt responses and fulfilling commitments.
Engages with patients and external parties to obtain necessary information for billing.
Experience
2-5 Years
Level
Management
Education
B.S. Health Admin.
Medicare Claims Specialist Resume
Objective : Healthcare professional with two years of experience specializing in Medicare claims processing and resolution. Expertise in analyzing claims discrepancies, ensuring compliance with Medicare regulations, and enhancing patient support services. Eager to leverage skills to improve operational efficiency and patient satisfaction in a dynamic healthcare environment.
Consistently increased cash collections through effective claims management.
Reduced aged accounts by 30% to ensure zero balances within 120 days.
Collaborated daily with the Coding department to resolve complex coding issues.
Reviewed correspondence to determine proper handling and response.
Verified insurance eligibility using HDX and Medicare Common Working File.
Keyed claims in the DDE system and processed adjustments through the Fiscal Intermediary Shared System.
Prepared and filed electronic claims, managing postings of credits and denials from Medicare Remittance Advices.
Experience
0-2 Years
Level
Entry Level
Education
AAS-HIT
Medicare Specialist Resume
Headline : Seasoned Medicare Specialist with 7 years of extensive experience in claims processing and regulatory compliance. Proficient in resolving complex claims issues while ensuring adherence to federal guidelines. Passionate about optimizing patient support and enhancing enrollment experiences through effective communication and problem-solving.
Performed billing and electronic transmission of Medicare claims with a focus on accuracy.
Submitted corrections for previously transmitted claims, ensuring compliance with federal regulations.
Processed electronic postings of Medicare and commercial carrier payments swiftly and efficiently.
Verified claim status for submitted claims through the IVR system, enhancing follow-up processes.
Managed reviews, appeals, and telephone hearings mandated by Medicare, advocating for claim resolutions.
Educated billing personnel on latest LMRPS and coding issues to optimize reimbursement processes.
Collaborated with SNF administrators to resolve consolidated billing issues and negotiate payments.
Experience
5-7 Years
Level
Management
Education
B.S. in HA
Associate Medicare Specialist Resume
Objective : Motivated healthcare professional with two years of experience in Medicare claims processing and customer support. Proficient in resolving billing discrepancies and ensuring compliance with Medicare regulations. Dedicated to improving patient experiences and providing exceptional assistance throughout the enrollment journey.
Skills : Claims Analysis, Empathy And Compassion, Patient Advocacy Skills, Telehealth Knowledge, Patient Education, Health Information Systems
Description :
Managed Medicare secondary accounts and billed all Medicare HMOs accurately.
Utilized reporting tools to monitor billing processes, identifying unbilled accounts.
Oversaw Medicaid accounts while training new representatives for seamless operations.
Investigated and rectified billing discrepancies, ensuring customer satisfaction.
Engaged with customers to resolve inquiries and issues related to accounts and billing.
Facilitated training sessions for new employees in various office roles.
Maintained compliance with federal regulations in all billing activities.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin.
Medicare Specialist Resume
Objective : Experienced Medicare Specialist with 5 years in claims processing and customer support. Proficient in navigating complex regulations and ensuring compliance while resolving claims effectively. Driven to enhance patient satisfaction through clear communication and dedicated service during the enrollment process.
Skills : Quality Assurance, Risk Assessment, Training And Mentoring, Report Generation, Medicare Advantage Plans, Medicare Part D Knowledge
Description :
Provided exceptional customer service and support to Medicare clients, addressing inquiries and concerns.
Compiled and evaluated documentation to ensure accurate and compliant claims submissions to Medicare.
Quickly adapted to the role, assisting colleagues in various departments to enhance workflow efficiency.
Utilized strong communication skills to foster collaboration among team members.
Demonstrated proficiency in new software applications, enhancing operational efficiency.
Maintained up-to-date knowledge of Medicare regulations to ensure compliance and accuracy.
Experience
2-5 Years
Level
Consultant
Education
B.S. in HA
Medicare Specialist Resume
Objective : Motivated Medicare Specialist with two years of experience in claims processing and customer support. Proficient in navigating complex regulations and enhancing patient satisfaction by resolving inquiries effectively. Eager to contribute to a dynamic team dedicated to improving healthcare access and compliance.
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