Medicare Compliance Coordinator

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.

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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.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
 
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).
 
QUALIFICATIONSEducation & 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.

TAKING CARE OF YOU BY

•  We offer a diverse and comprehensive benefits package including:
  • Three Medical, and two dental plans to choose from.
  • Tuition reimbursement eligible.
  • 401K plan that matches 50% on every $ you put in up to the first 6% you save.
  • 4 weeks PTO your first full year.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

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 $19.00-$23.00/hr.  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.

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.