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REMOTE Medicare Part D Claims Specialist (Bilingual)

Dallas, TX 75024

Posted: 01/07/2021 Employment Type: Direct Hire Industry: Medical Claim Examiner Job Number: 14882 Pay Rate Negotiable Based on Experience: 40,000 Branch: Dallas Office

Job Description


Medicare Part D Claims Analyst (Remote) 
Location for candidate (Texas) (Bi-Lingual) 

ESSENTIAL ROLES AND RESPONSIBILITIES

  1. Responsible for conducting quality check and reviews of Medicare Part D claims samples on a routine basis to ensure proper Medicare Part D claims parameter computations as well as suggesting new edits or claim alerts or reviews that could be applied in real time to ensure consistent and quality claims processing for Part D clients.
  2. Responsible for independently researching PDE errors related to clinical program parameters on claim transitions and providing mitigating steps for error resolutions. Analyze claims processing concerns related to Part D claims processing.
  3. Evaluate new processing business requirements and analyze claims requirements in order to ensure technical claims solutions are achieving the desired claim adjudication results.
  4. Responsible for reviewing and responding to Accumen PDE Edits reviews within established timelines and communicating to plan sponsors with resolution confirmations.
  5. Responsible for the distribution of PDE Error Summary Reports created monthly after submissions as well as the analysis of error trends noted in reporting that would need escalation.
  6. Responsible for the calculation and creation of adjustment claims for processing based upon technical, clinical and client eligibility errors.
  7. Responsible for the daily analysis of FIR transfers for benefit changes and the identification of impacted claims for intervention and review.
  8. Responsible for the updating and maintenance of PDE Error Manual Processes for Plan Sponsors. Reviews manual with clients as needed to assist in client training and education on client responsibilities in the PDE error handling process.

TRAINING AND EDUCATION

 
  • Bachelor’ s degree in finance, Information Technology or Healthcare related field; or equivalent experience.

 

REQUIREMENTS

The person must have:
  • Internet accessibility with or more than 10MB speed.
  • Personal cellphone.
  • Personal computer.

Additional Information

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Meet Your Recruiter

Sylvia Lemos
Recruiting Manager

I’m an experienced recruiter with a demonstrated history of working in the information technology and services industry. I have experience in skilled full-cycle recruitment for contract & direct hire roles, as well as on-boarding, sales, event management, team building, market research and management.

I like to make sure I keep the "Human" in Human Services and I am driven by others' success and prosperity. My everyday goal is just to make sure I am a little better than what I was yesterday.

What can you teach me? And what can I do to help you do the same? I believe honesty, integrity and communication are the 3 key ingredients to any successful partnership- I can't and won't conduct business without them.

Please feel free to reach out if you are a candidate seeking your next opportunity or a client needing top talent: slemos@hireupss.com

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