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Full-time Medicare Compliance Specialist - Work at Home

at Sedgwick CMS in Georgia

NOTE: This position may be considered a Work-At-Home opportunity for a qualified candidate. Medicare Compliance Specialist to be responsible for maintaining reliable internet and phone connectivity at their home. Must have dedicated work space for quiet work at home environment.

Medicare Compliance Specialist


Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."

To coordinate, analyze and facilitate Medicare Compliance and Medicare Set-Aside (MSA) functions within the assigned team.

Compiles, reviews and analyzes claim files and/or management reports and takes appropriate action.
Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses' analysis.
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
Communicates and advises appropriate internal and external stakeholders on Medicare Compliance and Medicare Set-Aside (MSA) matters including, but not limited to, lien negotiation efforts, MSA submissions and/or general information.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Analyzes and processes complex claims by investigating and gathering information to determine the exposure on the claims; manages claims through well-developed action plan to an appropriate and timely resolution.
Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.

Performs other duties as assigned.
Supports the total performance management initiative.
Travels as required.

Education & Licensing
BS/BA degree preferred.
Four (4) years claims management experience required. Experience with Medicare issues preferred.
Skills & Knowledge
Thorough knowledge of claims management
Excellent oral and written communication, including persuasive writing skills
PC literate, including Microsoft Office products
Strong analytical and interpretive skills
Strong organizational skills
Strong interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental:Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual:Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.They are not intended to constitute a comprehensive list of functions, duties, or local variances.Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick CMS is an Equal Opportunity Employer and a Drug-Free Workplace

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:

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Published on Mar 02, 2010
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