The Role
Investigates Medicare conditional payment referrals, obtains documentation, tracks claims with Medicare contractors, triages correspondence, updates systems and clients, verifies Medicare eligibility, and supports Medicare Advantage, Medicaid, and Treasury-related services while maintaining compliance, confidentiality, accuracy, and timely communication.
Summary Generated by Built In
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 managements’ 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.
About Us:
ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and
reporting solutions for the marketplace.
reporting solutions for the marketplace.
ECS is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
ExamWorks Compliance Solutions offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Skills Required
- Knowledge of business terminology, administration, and management
- Ability to operate a computer, fax machine, copier, scanner, and telephone
- Strong knowledge of Microsoft Word, Outlook, Excel, and the Internet
- Ability to perform basic arithmetic and compute rates and percentages
- Strong customer service skills
- Exceptional written and verbal communication skills
- Ability to follow instructions and management directions accurately
- Excellent English usage, grammar, punctuation, and style
- Ability to work independently, prioritize tasks, and manage time efficiently
- Ability to concentrate and multitask in a fast-paced environment
- Ability to maintain confidentiality
- Ability to work effectively in a team-oriented environment
- Ability to work under pressure and stressful conditions
- Ability to manage change, delays, and unexpected events appropriately
- Ability to follow company policies and procedures
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The Company
What We Do
ExamWorks Compliance Solutions is a leading authority on Medicare compliance and mandatory insurer reporting. The company provides comprehensive, customizable reporting and compliance solutions, including Medicare Set-Asides (MSAs), conditional payment services, and outcome management. Leveraging clinical and legal expertise, it serves property and casualty insurance carriers, law firms, and government agencies to manage complex medical and pharmaceutical claims.
