Conditional Payment Specialist

Role Description

The Conditional Payment Specialist is responsible for working with Medicare and its contractors to obtain documentation, ensure timely follow-ups are made, and timely and accurate updates are provided to clients. This position ensures all services are completed with the highest quality and integrity and all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.

This is a remote full-time position with a standard work schedule Monday-Friday, 8am-5pm EST or 9am-6pm EST. It may be necessary to work overtime depending on business needs.

Essential Job Functions

• Investigate new referrals, clarify information received with the Conditional Payment Referral Coordinator and the nature of the assignment with the client or Account Executive.
• Follow up with the applicable Medicare contractor to track status of each claim.
• Respond to internal and external emails and phone calls in a timely manner.
• Triage conditional payment correspondence upon receipt.
• Appropriate documentation of all system notes and e-mails.
• Work with Team Manager to ensure client correspondence is logical and up to date.
• Assist with addressing issues and solving problems as needed.
• Assist other team members as needed and directed by management.
• Regularly communicate with management and provide support as needed.
• Abide by all rules of the company such as safety, confidentiality and organizational directives.
• Perform Medicare Eligibility Inquiries and Verifications as needed.
• Perform Medicare Advantage Plan and Medicaid services as needed.
• Perform Treasury-related services as needed.
• Perform other duties as assigned by management.

Qualifications

• Must be knowledgeable with business terminology, administration and management.
• Must be able to adequately operate a computer, fax machine, copier, scanner, and telephone.
• Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals. Ability to compute rates and percentages.
• Ability to demonstrate strong customer service skills.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to follow instructions and respond to management’s directions accurately.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Ability to concentrate and multitask in a fast-paced work environment.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team-oriented environment.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

Benefits

• Competitive benefits (medical, vision, dental)
• Paid time off
• 401k