Job Description

MEDICAL CLAIMS PROCESSING SPECIALIST (MEDICARE/MEDICAID) – 100% REMOTE

Our client is a national leader in business process as a service (BPaaS) in business process outsourcing (BPO) of medical claims in the Medicare Advantage and Managed Medicaid markets.

Our client is looking for a number of full-time Medical Claims Processing Specialists who will work 100% remote from their homes, which means they can live anywhere in the U.S. Our client DOES NOT provide sponsorship for U.S. employment and candidates must be authorized to work in the U.S.

Our client’s corporate offices are located in the northern suburbs of Philadelphia.

This Medical Claims Processing Specialist will be required to perform reviews of pended claims of all types and specialties, apply business rules, and finalize claims in accordance with regulatory and client expectations.

RESPONSIBILITIES OF A MEDICAL CLAIMS PROCESSING SPECIALIST:

• Perform timely and accurate claim adjudication and adjustments.
• Prepare encounters for submission and correct rejected encounters.
• Identify opportunities to improve efficiency within assigned processes.
• Research and review Claims Appeals information to support client inquiries.
• Support system inquiries documented from the member and provider call center services.
• Adjudicate specialty claims, including ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.

REQUIREMENTS OF A MEDICAL CLAIMS PROCESSING SPECIALIST:

• 1 to 3 years of Medicare Advantage and Managed Medicaid experience.
• Experience in working in a remote BPaaS environment with performance standards.
• Excellent attention to detail and phone communication skills.
• Excellent written communication skills.
• Proficient with Microsoft Office Outlook, Word and Excel, and Adobe Standard.

This Medical Claims Processing Specialist position provides an hourly range of $16.00 to $18.00 per hour commensurate with experience along with benefits that include: Medical (pays 75% of selected coverage), Dental, 401(k) with match, Life, STD, LTD, 3 weeks PTO, and 10 paid Holidays.

PLEASE APPLY TO BE CONSIDERED