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Medicare associate sr.
If you care, there’s a place for you here
For a career path that is both challenging and rewarding, join sedgwick’s talented team of 27,000 colleagues around the globeSedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutionsTaking care of people is at the heart of everything we doMillions of people and organizations count on sedgwick each year to take care of their needs when they face a major life event or something unexpected happensWhether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidanceOur clients depend on our talented colleagues to take care of their most valuable assets—their employees, their customers and their propertyAt sedgwick, caring counts®Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
Sedgwick’s medicare compliance team assists clients with medicare set-asides (msas) and medicare liens, which can impact workers’ compensation and general, professional and auto liability claimsMsas are reports created with the purpose of protecting medicare’s future interest in the event of a settlementOur examiners use msas to negotiate settlements and the amount we should provide to claimants for post-settlement treatmentWe also assist with medicare liens, which include any payments made by medicare for the benefit of a claimant/plaintiff between the injury date and the settlement dateOur team reviews the liens for accuracy and handles any necessary negotiations to reduce them prior to settlement.
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. Job description
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.
Additional functions and responsibilities
Performs other duties as assigned. Supports the organization's quality program(s).
Education & licensing High school diploma or ged required.
Experience One (1) year of general office experience requiredClaims or medical records/billing industry experience preferredTwo (2) years of experience as medicare associate requiredMinimum 3.25 on most recent performance appraisal.
Skills & knowledge
Excellent oral and written communication skills Pc literate, including microsoft office products Analytical and interpretive skills Strong organizational skills Excellent 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 descriptionThey are not intended to constitute a comprehensive list of functions, duties, or local variancesManagement retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an equal opportunity employer and a drug-free workplace.
Medicare Associate Sr.
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