Medicare Specialist Job at CareerPaths NW (Tacoma)

Rcm specialist - medicare

You'll be part of a team that's driving innovation and leading the way in cloud-...

Location

United States

Salary:

16.98 - 25.46 USD / Hour

ResMed

Expiration Date

Until further notice

Requirements

Minimum of 2 years of Medicare Durable Medical Equipment billing and accounts receivable experience
2 years of experience in maintaining HIPAA standards
Proficient in using computers and Microsoft products (Excel and Word)
Strong motivation in billing, claims, and document management
Effective communication skills and problem-solving abilities
High school diploma required
equivalent education and experience considered
Broad knowledge of routines and procedures
Proven track record of working towards and exceeding metrics

Job Responsibility

Managing billing procedures
Resolving complex claims
Staying abreast of regulatory changes to maintain compliance
Engaging with internal and external stakeholders to streamline processes and optimize revenue outcomes
Collaborating with cross-functional teams to achieve service and sales goals

What we offer

Comprehensive medical, vision, dental, and life, AD&D, short-term and long-term disability insurance
Sleep care management
Health Savings Account (HSA)
Flexible Spending Account (FSA)
Commuter benefits
401(k)
Employee Stock Purchase Plan (ESPP)
Employee Assistance Program (EAP)
Tuition assistance
Fifteen days Paid Time Off (PTO) in first year

Fulltime

Medicare Managed Care Medical Collections Specialist

A hospital in Los Angeles is seeking a Medicare Managed Care Medical Collections...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous experience in medical collections, insurance follow-up, or healthcare accounts receivable required
Experience with Medicare managed care collections in a hospital or healthcare setting preferred
Strong knowledge of insurance appeals, denial management, and insurance AR follow-up
Familiarity with medical billing processes, payer guidelines, and reimbursement practices
Strong communication, negotiation, and problem-solving skills
Ability to organize and prioritize a high-volume workload in a fast-paced environment
Proficiency with hospital billing systems and electronic medical or revenue cycle platforms preferred
At least 3 years of experience in medical collections, insurance follow-up, or healthcare accounts receivable
Background in Medicare managed care or Medicare Advantage collections within a hospital or healthcare setting is preferred
Working knowledge of denial management, insurance appeals, and payer follow-up practices

Job Responsibility

Call insurance companies, payers, and/or patients to secure payment on unpaid claims
Perform timely follow-up on outstanding insurance accounts receivable to ensure appropriate reimbursement
Manage and prioritize daily workload to maximize collection efforts and minimize delays in payment resolution
Submit and track insurance appeals related to denied or underpaid claims
Review denials, determine root cause, and take corrective action to support claim resolution
Gather and provide required documentation to payers to support payment or appeal requests
Work closely with internal departments to resolve billing discrepancies and improve claim turnaround times
Maintain accurate account notes and update billing systems with collection and follow-up activity
Monitor unpaid claims to ensure timely escalation and resolution

What we offer

medical insurance
vision insurance
dental insurance
life insurance
disability insurance
401(k) plan

Fulltime

New

Korean Translation & Communication Specialist

We are looking for a creative and detail-oriented bilingual Korean Translation &...

Location

United States , Westminster

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Fluent in speaking, reading, and writing Korean and English
1+ years of professional written translation experience
Strong copywriting, proofreading, and editing abilities
Excellent grammar and attention to detail
Experience translating marketing or customer/member-facing communications
Highly organized with strong time management skills
Comfortable managing multiple projects simultaneously
Self-motivated with the ability to work independently in a remote environment

Job Responsibility

Translate written content from English to Korean while maintaining meaning, tone, and cultural relevance
Transcreate marketing and member communications for Korean-speaking audiences
Translate and proofread member letters, flyers, brochures, enrollment guides, sales collateral, marketing materials, and Medicare communications (ANOC, EOC, Summary of Benefits)
Edit and proofread translations completed by internal team members or outside vendors
Ensure translations are complete, accurate, and compliant with company standards
Maintain formatting, terminology, style, and editorial consistency
Manage multiple translation requests while meeting deadlines
Track work and project progress through Jira
Utilize translation software and internal translation databases
Provide cultural insight to ensure communications resonate appropriately with Korean-speaking members

What we offer

Medical
Vision
Dental
Life and disability insurance
401(k) plan

Parttime

New

Medical Collections Specialist

We are looking for a Medical Collections Specialist to join a healthcare team in...

Location

United States , Sacramento

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in medical collections, accounts receivable follow-up, or healthcare reimbursement functions
Strong understanding of Explanation of Benefits documents and insurance claim adjudication processes
Knowledge of patient financial responsibility concepts, including copays, deductibles, coinsurance, and out-of-pocket maximums
Familiarity with commercial insurance plans, PPO products, and Medicare Advantage reimbursement structures
Proven ability to write effective appeals for denied or underpaid medical claims
Confidence interacting with both insurance representatives and patients regarding account balances and claim outcomes
Ability to manage a high-volume workload, stay organized under pressure, and consistently achieve performance targets
Working knowledge of medical terminology and revenue cycle processes related to claim denials and reimbursement

Job Responsibility

Review payer contracts and reimbursement terms to determine correct allowed amounts and identify underpayments
Interpret Explanation of Benefits statements to evaluate claim decisions and confirm financial responsibility
Investigate denied, delayed, or partially paid claims and take appropriate action to secure proper reimbursement
Prepare clear, persuasive appeals that address payer findings and support claim reconsideration
Communicate with insurance carriers to resolve billing discrepancies, payment issues, and adjudication concerns
Speak with patients regarding outstanding balances, explaining how copays, deductibles, coinsurance, and out-of-pocket limits affect what they owe
Maintain consistent follow-up on assigned accounts while meeting productivity expectations in a fast-moving workload
Apply analytical judgment to determine the most effective next steps for account resolution and escalation when needed
Collaborate with team members to support collection goals and maintain quality standards across account follow-up activities

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

New

Actuarial Analyst III

The Actuarial Analyst III is responsible for completing very diverse and complic...

Location

United States of America , Norfolk; Denver; Indianapolis; Richmond

Salary:

94560.00 - 156024.00 USD / Year

Elevance Health

Expiration Date

July 09, 2026

Requirements

Requires a BA/BS and to have passed a minimum of four Society of Actuaries (SOA) actuarial exams and a minimum of 3 years related experience
or any combination of education and experience, which would provide an equivalent background

Job Responsibility

Analyzes and implements risk contracts including conducting experience analyses, pricing, filing and settlement work
and prepares management reports supporting new capitation initiatives
Assists in training of actuarial trainees, analysts and specialists
Coordinates/directs special actuarial projects
Supporting Medicare Part D pricing and forecasting activities, with a primary focus on evaluating and modeling the financial impacts of the Inflation Reduction Act (IRA)
Develop, maintain, and enhance pricing models used to assess the effects of evolving Part D benefit designs, manufacturer discounts, member cost-sharing changes, and federal risk-sharing provisions
The associate will work closely with the certifying actuary and broader Medicare actuarial team to support bid development, pricing strategy, and financial projections
Responsibilities include analyzing emerging experience, assessing regulatory guidance, translating policy changes into pricing assumptions, and quantifying the impact of legislative and market developments on plan performance

What we offer

comprehensive benefits package
incentive and recognition programs
equity stock purchase and 401k contribution
merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical
dental
vision

Fulltime

New

Appeals and Grievances Nurse Specialist RN II

The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provi...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of experience in Clinical RN
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment
Excellent interpersonal and communication skills
Computer literacy and adaptability to computer learning
Time management and priority setting skills
Must be organized and a team player
Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies
Good working knowledge of regulatory requirements/standards
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department
Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements
Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA)
Identification of Expedited Cases and resolution within 72 hours
Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation
Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE)
Process the case thru to effectuation and final case documentation in the A&G system of record
Investigation and preparation of State Fair Hearing cases as assigned
Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE)
Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Field Entitlement Enrollment Advocate

The Entitlement Advocate provides Healthfirst Medicare Advantage Plan(MAP), Mana...

Location

United States , New York

Salary:

42200.00 - 65960.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

High school diploma or GED from an accredited institution
Member facing or customer service experience
Be able to work 9am-5:30pm schedule
Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County
Capability to work in a Hybrid Schedule (remote/office/field)
Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint
Bilingual
Be able to communicate and engage with the leadership team on virtual platforms such as Zoom or Microsoft Teams chat as well as in person

Job Responsibility

Handle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals
Screen all incoming calls and handles accordingly
Transfer calls to appropriate staff, unit, or department
Assist callers requesting assistance with Medicaid Renewal application, Medicare Savings Program application, and New Medicaid Applications
Outreach Senior Health Partners, CompleteCare, and Life Improvement Plan members according to approved scripts
Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes
Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation
Document all client calls /outcomes in database systems
Schedule appointments to see members/prospects out in the field to assist with Medicaid Issue or restriction code removals or demographic information changes
Educate potential members on Senior Health Partners, Long term care plan benefits answering questions regarding plan’s features and benefits as well as go through eligibility and requirement for enrollment

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

Patient Financial Specialist Senior

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
3-5 years of experience preferred
Experience calculating expected reimbursement according to payer regulations and/or contracts required
Experience with Commercial, Medicare, and Medicaid reimbursement
Medicare, Medicaid, VA, Tricare billing and collections processes and regulations preferred
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience
Prefer hands-on experience with Medicare Remote (FISS) – DDE
Must have in-depth knowledge and ability to maneuver efficiently through Patient Accounting Systems, Document Imaging, Databases, etc.
Must have understanding of Medicare and Commercial contract language
Must have good technical aptitude working with a variety of MS Office products (Word, Excel, PowerPoint, Outlook) and/or ability to learn and develop more advance skills with the various applications

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics
Ensures PFS departmental quality and productivity standards are met
Functions as a subject matter expert in support of other PFS team members and other departments/facilities within the CHRISTUS Health network
Demonstrates a good understanding and has the ability to interact with the payer to verify coverage, submit claims, and follow up on appeals, underpayments, short pays or payment disputes for resolution
Investigate and resolve complex payment denials inclusive of correcting errors and supplying additional required information to facilitate collection of reimbursement / additional reimbursement
Ability to analyze, recognize, and resolve issues utilizing strategic thinking
Work with a variety of payers
Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned
Responsible for professional and effective written and verbal communication with both internal and external customers

Fulltime

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Medicare Specialist

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