About this role
The Conditional Payment Specialist plays a critical role in our operations by monitoring and tracking conditional payments on letters, notices, and demands. In this position, you will directly determine whether we can move forward with disputes or appeals. Working closely with Medicare and its contractors, you will secure essential documentation, ensure rigorous follow-up, and provide accurate, timely updates to clients. This role requires the highest standards of quality, integrity, and regulatory compliance.
Key Responsibilities
- Case Investigation: Review new referrals, clarify assignment details with the Conditional Payment Referral Coordinator, and align on project goals with clients or Account Executives.
- Medicare & Agency Liaison: Perform Medicare eligibility inquiries, verifications, and systematically follow up with Medicare contractors to track claim statuses.
- Correspondence Triage: Review, evaluate, and prioritize incoming conditional payment letters, notices, and legal demands.
- Comprehensive Documentation: Maintain meticulous, up-to-date system notes, emails, and logical client correspondence in alignment with the Team Manager.
- Specialized Support: Provide Medicare Advantage Plan, Medicaid, and Treasury-related services as directed by management.
- Team Collaboration: Troubleshoot internal issues, assist team members, and regularly communicate with management to support shifting business demands.
Qualifications
Must-Haves
- Education: Associates Degree or equivalent practical experience.
- Experience: 1 to 3 years of administrative or clerical experience.
- Communication Skills: Exceptional written and verbal communication, including a strong grasp of English grammar, editing, and business terminology.
- Technical Proficiency: Strong computer skills, including deep familiarity with Microsoft Word, Outlook, Excel, and online research tools.
- Analytical Ability: Ability to analyze itemized medical billing statements, medical records, and legal contracts, alongside basic math proficiency (rates, percentages, and fractions).
- Work Style: Ability to thrive under pressure, multitask in a fast-paced environment, and manage sensitive, confidential information.
Nice-to-Haves
- Experience working within the insurance, legal, or clinical industries.
- Direct exposure to Medicare rules, contractors, and processes.
ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.