Medicare Exhaust Specialist

Medicare Exhaust Specialist

Are you results-oriented? Our dynamic team has the responsibility of resolving outstanding insurance claims so that our patients are not impacted.

We offer an exceptional employee experience, full-time hours, full benefits, paid training, and advancement opportunities. Our team offers flexible, first-shift, Monday through Friday schedules. This would include two fifteen-minute breaks and one half-hour lunch. We allow for casual work attire; jeans are our norm!

The Medicare Exhaust Specialist supports the accounts of patients who have exhausted their Medicare benefits during their stay in our facility. They take ownership of the account to bill and collect from all insurances involved: Medicare, Medicaid, Commercial, etc. Their goal is to accurately collect revenue from the secondary insurances based on benefit limitation, eligibility, state requirements, and exhaustion date.

This is an important part of the job

Multitasking during the day

Role involves outbound call activity on a daily basis, including reaching out to insurance companies and patients

Responsible for following up on escalated cases from the CSR team, completing research, resolving outstanding issues, and providing callbacks

Handles account research and insurance inquiries, including gathering information and asking detailed questions

Candidates should expect to be on the phone consistently throughout the day regardless of inbound call volume

Responsibilities

• Reviews in-house patient's use of Medicare days to determine the date Medicare will exhaust. Notifies facility staff as to the collectability of services performed after Medicare benefits are exhausted.
• Once patient determined to be Medicare Exhaust, specialist files Medicare part A and part B claims to Medicare.
• Specialist determines if a secondary insurance is available and if it will pay for services rendered after Medicare days are exhausted. Ensures all authorizations are obtained as necessary and sends claims to secondary (commercial/Medicaid) payers along with Medicare remittance advise(s) for payment.
• Performs all necessary collection efforts with Medicare and the Commercial/Medicaid payers to obtain correct payment for services rendered in a timely manner. This includes making phone calls and writing appeals. Often works with provider representatives at the payers.
• Make creative connections based on our contracts with payers, how they process as primary, how they want to be billed as secondary, and how the account was reimbursed overall to be able to close Exhaust accounts.
• Provide detailed timelines of events and actions taken on individual accounts to Business Office Manager with the goal of making decisions on revenue.
• Conducts investigations to discover the root cause of unpaid or underpaid claims or reimbursements. Audits records and documentation to ensure all required paperwork and supporting materials have been submitted properly. Initiates escalated collection procedures with the goal of generating increased revenue and reducing the number of delinquent, nonresponsive, or unresolved accounts.
• Utilize data analytics tools to identify trends and patterns in claim denials, overpayments, and underpayments. Convey these trends to the team during weekly meetings so processes can be updated.
• Reviews all Payments / Adjustments / uncollectable balances to ensure accurate posting in the revenue cycle system.
• Research state, federal and payer specific payment and collection regulations.
• Prioritize additional duties or high risk accounts as assigned by CBO Leadership.
• Supports the mission and direction of Select Medical Corporation.

Qualifications

Required:

• High School diploma required.
• Minimum three years collection experience.

Preferred:

• Excellent problem solving skills
• Good interpersonal, oral and written communication skills.
• Strong organizational skills with an ability to prioritize to meet deadlines and manage multiple projects.
• Ability to work independently with minimal instruction or supervision
• Proficient in Windows based office technologies (ex. Word, Excel, PowerPoint).

Additional Data

Select Medical strives to provide our employees with a solid work-life balance, as we understand that happy employees have both fulfilling careers and fulfilling lives beyond our doors.

• An extensive and thorough paid orientation program.
• Paid Time Off (PTO) and Extended Illness Days (EID).
• Health, Dental, and Vision Insurance; Life insurance; Prescription coverage.
• A 401(k) retirement plan with company match.
• No Required Weekends

Working Conditions/Physical Demands:

• Office Environment
• Sitting for extended periods of time
• Ability to lift weight up to 35 lbs.

Equal Opportunity Employer/including Disabled/Veterans