Sr. Medicare Associate

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Sr. Medicare Associate

PRIMARY PURPOSE

To gather documentation required to complete Medicare Compliance referrals in a timely manner; to upload referrals to Medicare Compliance System (MCS); to review the pay histories and medical records for adequacy; and to resolve technically difficult record files.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

Reviews JURIS pay ledger as a guide to locate medical records needed for MCS assignment; analyzes additional records to determine if they are pertinent to Medicare Set Aside (MSA); and determines appropriate course of action. Pulls and sorts medical records required for complex Medicare Compliance referral from appropriate sources; identifies missing document/records; requests missing documentation from provider, examiner and/or defense counsel. Handles complex records issues by identifying and seeking out critical records to create a file that meets government requirements. Reviews and submits medical records to nurses to enable them to complete referral in a timely manner; uploads referrals and reports from claims system into MCS; ensures MCS is updated properly. Responds to questions from examiners about Medicare Compliance processes and products. Documents activity in MCS; communicates MCS action with examiner via JURIS notes. Creates daily reports to manage workload and monitors due dates. Communicates with examiners and defense counsel to resolve technically difficult issues related to obtaining medial records. Assists in training new departmental colleagues. Assists with special client projects as needed.

QUALIFICATIONS

Education & Licensing:

High school diploma or GED required.

Experience:

One (1) year of general office experience required. Claims or medical records/billing industry experience preferred. Two (2) years of experience as Medicare Associate required.

Skills:

Excellent oral and written communication skills, PC literate, including Microsoft Office products, analytical and interpretive skills, and ability to meet or exceed Performance Competencies Work environment requirements include -

Physical:

Computer keyboarding

Auditory/visual:

Hearing, vision and talking

Mental:

Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. When applicable and appropriate, consideration will be given to reasonable accommodations. 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 $20.00 per hour . 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. 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. 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. Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com