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Ochsner Clinic Foundation
New Orleans, LA, United States
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, andinnovate.Webelieve that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsne
Job Source: Ochsner Clinic FoundationOchsner Health
New Orleans, LA, United States
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner, whether you work with patients every da
Job Source: Ochsner HealthOchsner Clinic Foundation
New Orleans, LA, United States
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, andinnovate.Webelieve that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner,
Job Source: Ochsner Clinic FoundationLife Balance Transition
New Orleans, LA, United States
"Don't fear failure. Fear being in the exact same place next year as you are today." Michael Hyatt Are you currently navigating a career crossroads, feeling disillusioned with your current role, confined in a routine, or ready to embark on a new phase beyond the confines of traditional corporate life? Then for individuals with an entrepreneurial
Job Source: Life Balance TransitionOchsner Health
New Orleans, LA, United States
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner, whether you work with patients every da
Job Source: Ochsner HealthCengage Group
New Orleans
**We believe in the power and joy of learning** At Cengage Group, our employees have a direct impact in helping students around the world discover the power and joy of learning. We are bonded by our shared purpose – driving innovation that helps millions of learners improve their lives and achieve their dreams through education. **Our culture value
Job Source: Cengage GroupWorkoo Technologies
New Orleans, LA, United States
About the job Remote - Data Entry Specialist POSITION SUMMARY: The position involves entering information into the company's database/computer system in order to facilitate the process of documenting and retrieving information for all warehouse transactions performed by the company. To perform this job successfully, the individual must be able to
Job Source: Workoo TechnologiesTravel by Tilly
Marrero, LA, United States
Join our dynamic team and immerse yourself in an environment that's all about support, fun, and creating unforgettable memories that last a lifetime! We firmly believe that while things may fade, experiences are forever priceless. Explore a world of growth opportunities, top-notch training, enticing company perks, and the flexibility of working hou
Job Source: Travel by TillyNew Orleans, LA, United States
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
PRIMARY PURPOSE : To coordinate, analyze and facilitate Medicare Compliance and Medicare Set-Aside (MSA) functions within the assigned team.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Compiles, reviews and analyzes claim files and/or management reports.
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.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Four (4) years claims management experience or equivalent combination of experience and education 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
WORK ENVIRONMENT
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
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.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $54,000 to $61,000 . A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
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Medicare Specialist (Remote) jobs in New Orleans, LA, United States
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