Medicare Follow-Up Representative

TeleSpecialists Job Post

TeleSpecialists is transforming healthcare delivery as the nation's largest and fastest-growing digital healthcare leader. By providing expert neurological and psychiatric care directly to over 400 hospitals and health systems across the country, we don't just provide care; we pioneer solutions that make quality healthcare easily accessible.

Join a team where your passion meets our purpose. If you're inspired by innovation, thrive in a collaborative and entrepreneurial environment, and want to be a part of a team that's reshaping the future of patient care, we want you on our team. At TeleSpecialists, you'll discover more than just a job. You will be able to experience meaningful work, accelerated career growth, and the opportunity to redefine healthcare for the future.

Tele Specialists Offers:

• A great culture with a team environment
• A fun, diverse work environment
• A rapidly growing company with career advancement opportunities
• Medical, Dental and Vision benefits
• Tuition Reimbursement
• 401k match
• Paid Vacation
• Leadership Training Classes
• Mentorship Program

About the Role

We are seeking a detail-oriented Medicare Follow-Up Representative to support revenue cycle operations by managing claim follow-up, denials, appeals, and payment resolution for Medicare and secondary payers. This role requires strong experience with multi-state claims, Medicare Administrative Contractor (MAC) portals, telemedicine billing, and HCFA 1500 (CMS-1500) professional claims.

The ideal candidate has hands-on experience with Medicare claim workflows, strong problem-solving skills, and the ability to efficiently resolve claim issues to maximize collections and reduce aging accounts receivable.

• Conduct Medicare claim follow-up to resolve unpaid, denied, or pending claims
• Work claims across multiple MAC portals (e.g., Novitas, First Coast, Palmetto, Noridian, WPS, NGS)
• Research and resolve claim denials, payment discrepancies, and rejections
• Prepare and submit appeals, reconsiderations, and corrected claims when necessary
• Review and correct claims billed on HCFA 1500 (CMS-1500) forms
• Handle multi-state Medicare and commercial claims, ensuring payer-specific compliance
• Follow up on telemedicine and tele-neurology claims, including place-of-service and modifier accuracy
• Review EOBs/ERAs to ensure accurate posting and payment validation
• Document claim activity and resolution notes in billing and workflow systems
• Identify trends in denials and escalate recurring issues to leadership
• Maintain productivity standards for claim volume, resolution timelines, and aging reduction
• Collaborate with billing, coding, enrollment, and compliance teams to prevent repeat denials
• Support AR cleanup initiatives and special payer projects as assigned

Required Qualifications

• 2+ years of Medicare AR follow-up or payer collections experience
• Strong working knowledge of Medicare claim processing and MAC portals
• Experience with HCFA 1500 / CMS-1500 professional claim billing
• Proven experience managing denials, appeals, and claim corrections
• Experience handling multi-state claims and payer-specific requirements
• Familiarity with telehealth and telemedicine billing workflows
• Ability to interpret EOBs, ERAs, and remittance advice
• Strong attention to detail, organization, and documentation skills
• Ability to meet productivity goals in a fast-paced AR environment

Preferred / Desired Experience

• Experience with tele-neurology or specialty telemedicine services
• Experience submitting and managing Medicare appeals and redeterminations
• Working knowledge of Salesforce (or CRM/workflow platforms)
• Experience with Waystar clearinghouse and claim scrubbing tools
• Experience working in telehealth or multi-state provider organizations
• Familiarity with Medicare secondary and crossover claims
• Prior experience with large AR inventories and aging reduction projects

Key Skills & Competencies

• Medicare payer expertise and portal navigation
• Denial management and appeals resolution
• Multi-state claim processing
• Strong analytical and research skills
• High attention to detail and compliance
• Strong written documentation and communication skills
• Time management and productivity discipline
• Team collaboration and escalation judgment