[Hiring] Medicare Specialist REMOTE USA
Position: Medicare Specialist
Date Posted: August 8, 2025
Industry: Healthcare / Medical Billing
Employment Type: Full Time
Experience: Not Specified
Qualification: Estimated Qualification like Diploma/Degree/Certificate in Healthcare Administration, Billing, or Related Field
Location: Louisville, United States (REMOTE)
Company: UofL Health
Description:
UofL Health is actively seeking a detail-oriented Medicare Specialist to join their remote billing and reimbursement team. This role plays a critical part in ensuring accurate billing and timely follow-up for Medicare and Medicare Advantage claims. Candidates must have deep knowledge of Medicare processes, including eligibility, benefits, and billing regulations, along with a thorough understanding of the Direct Data Entry (DDE) system and Uniform Billing procedures.
Primary Duties and Responsibilities:
• Monitor and resolve claims listed on the Discharged Not Final Billed (DNFB) report.
• Ensure claims are filed electronically unless specific payers require paper submissions.
• Identify payers not accepting electronic claims and communicate with leadership to explore opportunities.
• Timely follow-up on unpaid Medicare and Medicare Advantage claims, with focused attention on high-dollar accounts.
• Analyze and interpret Explanation of Benefits (EOBs) and remittance advices.
• Generate statements for any outstanding patient balances.
• Use insurance portals and websites to manage and resolve open claims.
• Conduct thorough follow-up and provide detailed problem account analyses.
• Log all collection and follow-up actions accurately in the Accounts Receivable system.
• Submit shadow claims for inpatient Medicare Advantage payers.
• Maintain awareness of the inpatient-only procedure list and collaborate with the Revenue Cycle team to prevent claim denials.
• Audit account balances, payment postings, and contractual adjustments for accuracy.
• Adhere strictly to Medicare Secondary Payer Questionnaire protocols.
• Coordinate medical record requests and ensure timely documentation and submission.
• Forward Recovery Audit Contractor (RAC) documentation to Denials/Appeals Specialists as needed.
• Recognize and report payment trend issues that impact reimbursement.
• Communicate with patients, physician offices, and legal representatives when required to gather missing information.
• Work assigned claims efficiently while meeting established productivity targets.
• Complete tasks within designated deadlines.
• Participate in educational seminars as assigned.
• Perform additional related duties as required by the department.
This opportunity is ideal for professionals who excel in a remote work environment and are passionate about accurate billing and improving healthcare financial processes.
Disclaimer: The job details above are structured for clarity and based on publicly available content from recruiters/Company pages. All rights remain with the original source; names may be withheld for confidentiality. We are not involved in the hiring process.
