Offer summary

Qualifications:

High school diploma or GED required., One year of general office experience or equivalent combination of education and experience required., Excellent oral and written communication skills are essential., Strong organizational and analytical skills are necessary for the role..

Key responsabilities:

Gather and sort medical records for Medicare compliance referrals in a timely manner.

Upload referrals to the Medicare Compliance System (MCS) and ensure it is updated properly.

Communicate with examiners regarding Medicare compliance processes and maintain professional client relationships.

Process incoming mail and document activities in MCS.

Job description

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®
Forbes Best-in-State Employer

Medicare Compliance Coordinator

PRIMARY PURPOSE: To gather documentation required to complete Medicare compliance referrals in a timely manner; to upload referrals to Medicare Compliance System (MCS); and to handle incoming mail.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Pulls and sorts medical records required for Medicare compliance referral from a appropriate sources; identifies missing documents/records; requests missing documentation from provider, examiner and/or defense counsel.
• Analyzes and submits medical records to nurses to enable them to complete referral in a timely manner; uploads referrals and reports from claims system into Medicare Compliance System (MCS); ensures MCS is updated properly.
• Analyzes 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.
• Documents records handler activity in MCS; communicates MCS action with examiner via JURIS notes.
• Responds to questions from examiners about Medicare compliance processes and products.
• Maintains professional client relationships.
• Sorts available records in DOS order.
• Processes mail.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
High school diploma or GED required.

Experience
One (1) year of general office experience or equivalent combination of education and experience required. Claims or medical records/billing industry experience preferred.

Skills & Knowledge

• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good 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.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.