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Medicare Claims Resolution Specialist – Sarnova

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The Medicare Billing Representative is primarily responsible for working claims after they’ve been submitted to Medicare. This position requires an individual who demonstrates strong follow-through, close attention to detail, and the ability to multi-task.


Organizational Impact:


In this role for Digitech, you are our brand ambassador for our clients and the Medicare patients that they serve. You impact your line of business by ensuring Medicare’s rules, regulations and timely filing limits are adhered to and identifying and addressing issues causing claims to remain on hold, so that all claims are paid.


Essential Duties and Responsibilities:

  • Work claims that are pending too long at Medicare, are unable to be released or have been denied or incorrectly paid by Medicare.
  • Review claims that have been put on hold, working to identify causes and address issues causing them to remain on hold
  • Work denials aiming to identify whether or not Medicare denied the claim correctly, and handle follow-up accordingly.
  • Provide Medicare additional information as necessary to process a claim correctly and/or send an appeal.
  • Handle all correspondence via mail, email and any necessary refunds; perform other duties as assigned by management

Skills/Experience Required:

  • Strong computer skills. Basic understanding of MS Outlook, Word and Excel.
  • Minimum typing of 40 wpm.
  • Ability to handle large volumes of work while meeting tight deadlines
  • Experience in an environment where calls were monitored and scored as well as metrics applied to individual performance is helpful.
  • Ability to deal calmly and effectively with situations via telephone while maintaining and promoting a positive company image.
  • Excellent communication skills, both written and verbal. Able to present information and solutions in a professional and courteous manner.
  • Excellent attention to detail and accuracy.
  • Able to organize and prioritize tasks in order to complete all work assigned.