The Medicare Specialist researches, maintains, updates and creates new methodologies for Medicare payment systems to implement in Prime Health Services’ (PHS) suite of products as appropriate and understands NCCI/MUE billing edits as related to Prime products.
What You'll Do
- Researches and deciphers complex legal and regulatory sources regarding payment rules for Medicare payment systems
- Collaborates with Regulatory Compliance colleagues on how Medicare rules apply to Personal Injury Protection and Workers Compensation reimbursement
- Drafts concise documentation for payment procedures—including payment calculation logic—and interacting with the development team to refine that documentation into user stories and project plans
- Creates and updates internal documentation and processes, as needed for all Medicare based products
- Identifies issues upfront and communicate clearly to team members and leadership
- Manages competing priorities and delivers quality information and analysis while adhering to deadlines
- Develops, manages, and maintains rules in the PHS proprietary bill review software for all Medicare payment policies and systems
- Reports any showstopper issues to the Director of Compliance
- Performs unit and acceptance testing as necessary
- Performs other duties as assigned
