Conditional Payment Specialist - Examworks Group, Inc.

Do you have exceptional MEDICAL or LEGAL experience and consider yourself highly organized with great customer service skills? If so, our Conditional Payment Specialist may be the role for you!

The Conditional Payment Specialist is responsible for coordinating working with Medicare and its contractors to obtain documentation, ensuring timely follow ups are made, and timely and accurate updates are provided to clients. This position ensures all services are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.

This is a remote full time position with a standard work schedule Monday-Friday, 8am-5pm EST.  It may be necessary to work overtime depending on business needs.

• Investigation of new referrals, clarifying information received with the Conditional Payment Referral Coordinator and the nature of the assignment with the client or Account Executive.
• Follow up with the applicable Medicare contractor to track status of each claim
• Respond to internal and external emails and phone calls in a timely manner.
• Triage conditional payment correspondence upon receipt
• Appropriate documentation of all system notes and e-mails.
• Working with Team Manager to ensure client correspondence is logical and up to date.
• Assist with addressing issues and solving problems as needed.
• Assist other team members as needed and directed by management.
• Regularly communicates with management and provides support as needed.
• Abide by all rules of the company such as safety, confidentiality and organizational directives.
• Perform Medicare Eligibility Inquiries and Verifications as needed.
• Perform Medicare Advantage Plan and Medicaid services as needed
• Perform Treasury-related services as needed.
• Perform other duties as assigned by management.

QUALIFICATIONS 

• Minimum 1-3 years of Medicare Secondary Payer Compliance experience
• Minimum 1-3 years of administrative clerical experience.
• Ability to demonstrate strong customer service skills.
• Must demonstrate excellent working remotely
• Knowledgeable with business terminology, administration and management.
• Must be able to adequately operate a computer, fax machine, copier, scanner, and telephone.
• Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.  
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals. Ability to compute rates and percentages.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to follow instructions and respond to managements’ directions accurately.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Ability to concentrate and multitask in a fast paced work environment.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately. 
• Demonstrates reliability and abides by the company attendance policy.
• Must maintain a professional and clean appearance at all times consistent with company standards.
• Experience in the Medicare Secondary Payer Compliance insurance industry strongly preferred.

LANGUAGE/COMMUNICATION SKILLS

• Ability to read, analyze and interpret common correspondence, medical records, various reporting records, and/or related case documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management and/or members of the business community. 
• Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.

About Us:

ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and
reporting solutions for the marketplace. 

ECS is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
 
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks Compliance Solutions offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.