This site uses cookies. To find out more, see our Cookies Policy

Remote Medicare Denial Claims Specialist in Atlanta, GA at Prestige Staffing

Date Posted: 9/16/2018

Job Snapshot

  • Employee Type:
  • Location:
    8010 Roswell Road
    Atlanta, GA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

JobID: 18970

Prestige Staffing is looking for a Medicare Subject Matter Expert. This MCR SME will work on hospital denied claims. This is a direct hire position and will work remote from somewhere in the USA. Must have high speed internet and a designated work space. Monday – Friday normal business hours on the eastern time zone. Competitive pay with a bonus. 


The Medicare Denial Claims Specialist is responsible for resolving previously denied third-party payer claims for a variety of hospital providers. This Specialist must be able to multi-task and prioritize as necessary to timely resolve accounts for payment. Specialists communicate with payers on a daily basis, and must be able to draft appeals and patient correspondence in a professional manner. Specialists are required to demonstrate proficient use of web-based client and payer portals, along with notation databases. Specialist needs to have a dedicated work space at home and be a self-motivator and task oriented to work accounts in a professional manner as if they were working in an office with no distractions.

Duties Include:

  • Self-motivate to achieve monthly team revenue goals within virtual business office environment
  • Identify and resolve underlying complex denials to obtain timely payment of claims for clients
  • Respectfully implement client specific protocols and procedures
  • Manage a personal account inventory made up of diverse clients and complex denials
  • Make initial calls on all new accounts, and maintain professional relationships with payer representatives
  • Work new accounts and priority accounts within 48 business hours
  • Use professional notation that is clear, concise, and comprehensive throughout the complex denial resolution process
  • Demonstrate proficiency with web portals, client systems, and databases as necessary to document and resolve accounts
  • Identify accounts that require substantive review by the coding and utilization review departments
  • Timely prepare and submit appeals with required documentation
  • Ability to review a medical record and substantiate an argument based on medical necessity from the review of the medical record
  • Understand and know how to appeal no authorization denials
  • Proactively communicate questions and concerns to supervisor for resolution
  • Review high dollar and aged accounts as necessary to ensure efficient revenue cycle recovery
  • Communicate recent payer resolution trends with team


  • High School diploma or GED required
  • Minimum of 3 years' experience with Third party denials and appeals writing.
  • 5+ years of recent experience with Medicare intermediaries
  • Very knowledgeable of typical Medicare denials, and the Medicare appeals process (including MUE edits)
  • Several years of hospital business office billing and collections
  • Self-Disciplined, organized and detail oriented
  • Strong written and oral communication
  • Critical thinking, problem solving and decision making skills essential
  • Ability to multi-task and prioritize needs to meet timelines
  • Experience with Microsoft Word and Excel 

Interested parties apply today to be considered.