Medicare Specialist
Omaha, Nebraska
Operations – Claims Operations /
Exempt /
Hybrid
Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for a Medicare Specialist to be based in our Omaha, Nebraska office. This individual is responsible for protecting the company's interests with the Centers for Medicare and Medicaid Services (CMS) and U.S. Department of the Treasury (DOT) relating to payments for recovering workers eligible for Medicare and Medicaid benefits. The Medicare Specialist analyzes CMS payment requests and provides appropriate and timely recommendations to Claims Adjusting teams regarding payment, disputes, and appeals.
ESSENTIAL RESPONSIBILITIES
- Analyzes claim files, as well as requests and documents from government agencies, including Centers for Medicare and Medicaid Services (CMS) and U.S. Department of the Treasury (DOT), regarding payments for recovering workers eligible for Medicare and Medicaid benefits.
- Determines and provides appropriate, accurate, and timely course-of-action recommendations to Claims Adjusting teams based on analysis of all relevant data; provides recommendations for payment, dispute, and appeal strategies.
- Effectively answers questions from recovering workers via phone and email, and makes performs claim updates in the claim system and with CMS.
- Produces effective and professional written disputes and appeals that support the company's position to Benefits Coordination and Recovery Center (BCRC), Commercial Repayment Center (CRC), Department of the Treasury (DOT), and collection agencies.
- Effectively manages calls from collection agencies regarding conditional payment liens and correspondence from various parties to assist with Medicare-related concerns.
- Monitors dispute and appeal determination statuses and takes appropriate action to pursue favorable outcomes.
- Tracks lien amounts, disputes, and final conditional payment and DOT offset determinations; follows up as necessary.
- Identifies billing trends and suggests appropriate action; notifies appropriate department(s) for additional review.
- Monitors statute of limitations and regulatory requirements used in the decision-making process; maintains knowledge and shares information with appropriate parties.
- Successfully completes all required training timely.
- Assists effectively with a variety of Claims projects as needed.
- Fosters a positive working relationship with other company staff and external parties to cultivate a collaborative working environment.
REQUIRED QUALIFICATIONS
- EDUCATION: High school diploma or equivalent certificate required. Bachelor's degree from an accredited college or university preferred.
- EXPERIENCE: A minimum of two (2) years of experience in workers compensation adjusting and/or as a Medicare Specialist within the workers compensation industry.
SKILLS NEEDED FOR SUCCESS
- Able to read and interpret complex documents including statutes, regulations, legal opinions, legal correspondence, medical records and reports, medical bills, medical resource materials, investigation reports, claim notes, and claim data fields.
- Strong personal computer skills. Able to effectively use Microsoft Office software and be able to master and become proficient in proprietary and vendor software programs.
- Able to investigate, persuade, and negotiate over the telephone.
- Able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Able to compute rate, ratio, and percent. Familiar with the time value of money and reducing future streams of payments to a present value.
- Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
- Able to synthesize complex and/or diverse information, including highly technical data relating to claims handling. Identifies patterns, causal relations, and items requiring additional information or action and escalates appropriately. Able to use intuition and experience effectively to complement data.
- Effective communicator with strong interpersonal skills. Communicates clearly and appropriately using effective verbal, listening, reading, and writing skills. Asks questions freely to broaden knowledge and skills. Listens and gets clarification. Responds well to questions and feedback. Contributes effectively in meetings.
- Displays confidence and willingness to make timely decisions. Exhibits sound and accurate judgment. Supports and explains reasoning for decisions. Includes appropriate people in decision-making process.
WHAT WE OFFER
- Work-Life Balance
- Work From Home Program (up to 2 days per week upon eligibility)
- Office Within Walking Distance of The Old Market
- Free On-Site Fitness Facility
- Garage Parking
BENEFITS
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Accident and Critical Illness Insurance
- Flexible Savings Accounts
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program - Earn $ for your hired referrals!
- Diversity, Equity and Inclusion Program - Employee Resource Groups
ABOUT US
With more than 50 years in business, Berkshire Hathaway Homestate Companies has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.
At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. We’ve created an approachable and collaborative atmosphere. Here you’ll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
