Workplace Type: Onsite – hybrid potential (local candidates only)
Employment Type: FT (40hrs/wk.)
Job Location: Barberton, OH
JOB SUMMARY
The Medicare Authorization Support Representative supports the accuracy and efficiency of bill processing for senior members by reviewing, validating, and authorizing medical bills in alignment with CHM guidelines and Senior Share processes. This role ensures timely, compliant, and member-centered service while contributing to the overall effectiveness of the Member Care and Bill Processing team. The position plays a key role in upholding data integrity, supporting member inquiries, and advancing CHM’s mission through compassionate and detail-oriented work.
PRIMARY RESPONSIBILITIES
Medicare Bill Review & Authorization
- Reviews and validates Medicare Summary Notices (MSNs), Explanations of Benefits (EOBs) and general medical billing for accuracy and completeness
- Authorizes medical bills in accordance with CHM guidelines and established standard operating procedures
Member & Internal Support
- Serves as a primary communication resource by responding to member inquiries via phone and email regarding authorization status, eligibility, and program-related questions in accordance with CHM Guidelines
- Serves as a point of contact for staff inquiries via phone and email, providing timely and accurate information
- Provide clear, compassionate member support by helping members understand sharing status, next steps, and program terms at an appropriate level of detail
- Apply guideline knowledge to communication by determining appropriate next steps and delivering accurate, consistent guidance to members and internal staff
- Escalates complex or unresolved issues to the appropriate leadership level
Data Accuracy & Documentation
- Ensures accuracy and integrity of data entered and maintained within systems
- Maintains organized and complete documentation to support compliance and audit readiness
Operational Execution & Productivity
- Manages daily workload to meet productivity and quality standards
- Responds to correspondence and completes assigned tasks within established timelines
- Collaborate with Team Lead & Team Lead Assistant to improve scripts, templates, and educational resources that support consistent messaging
Team Collaboration & Continuous Improvement
- Collaborates with team members and leadership to support departmental goals
- Identifies and communicates process improvement opportunities to enhance efficiency and accuracy
CORE COMPENTENCIES & SKILLS
- Attention to Detail & Accuracy
- Communication (Written & Verbal)
- Organizational & Time Management
- Problem Solving & Initiative
- Customer Service Orientation
- Confidentiality & Accountability
- Ability to model CHM’s Core Values and Mission Statement in all interactions
REQUIRED QUALIFICATIONS
- High School Diploma or equivalent
- 1-2 years of administrative, healthcare, insurance, or billing-related experience preferred
- Proficiency in Microsoft Office (Excel, Work, Outlook)
- Experience reviewing medical billing documents (MSNs/EOBs) or similar documentation preferred