Westfield - Seville, OH
posted 22 days ago
Full-time - Mid Level
Seville, OH
1,001-5,000 employees
Educational Services
About the position
The Medicare Claims Compliance Senior Representative plays a crucial role within the Medicare Compliance Unit, focusing on complex claim assignments and ensuring adherence to Medicare regulations. This position involves providing support to claims professionals, identifying reporting errors, and assisting in regulatory mandated Medicare reporting, all while maintaining effective communication with various stakeholders.
Responsibilities
- Develop and maintain a thorough knowledge of Medicare Section 111 Reporting and Medicare as Secondary Payer requirements.
- Participate in process improvement initiatives to streamline claims processing operations and reduce compliance-related risks.
- Provide day-to-day, claim-specific support to claims professionals on Medicare Compliance.
- Identify, analyze, and correct reporting errors including defects/trends.
- Coordinate services with Medicare service vendors and claims professionals.
- Open cases with Medicare as needed and complete all regulatory mandated Medicare reporting.
- Review cases for Medicare conditional payments disputes and escalate to Medicare Compliance Specialist as necessary.
- Perform ad-hoc individual claim file reviews to assist claims professionals with Medicare compliance issues.
- Participate in various internal/external compliance audits.
- Maintain effective communication with claims department staff, internal and external business partners, insureds, claimants, agents, attorneys, and vendors.
- Ensure customer service excellence and provide excellent service to claims professionals and project teams.
- Assist in filing regulatory forms to maintain Medicare portal access and utilize the MSPRP for information requests.
Requirements
- 3-5 years of experience in Claims Compliance or a related field.
- Bachelor's degree in Business Administration or a related field and/or commensurate work experience.
Nice-to-haves
- Experience with Medicare Secondary Payer Recovery Portal (MSPRP)
- Knowledge of insurance industry regulations and compliance standards.
Benefits
- Diversity and inclusion commitment
- Opportunities for professional development
