Medicare Advantage Claims Processor - 100% remote

Responsibilities

• Perform timely and accurate claim adjudication and adjustments
• Adjudicate specialty claims, including, but not limited to ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.
• Prepare encounters for submission and correct rejected encounters
• Support system inquiries documented from the member and provider call center services
• Research and review Claims Appeals information to support client inquiries
• Meet established production and quality standards
• Identify opportunities to improve efficiency within assigned processes
• Minimum Requirements
• 1-3 years in healthcare industry experience working in the payer segment in Medicare Advantage, Managed Medicaid, or working with an industry competitor.
• Experience in BPaaS environment is a plus.
• Candidate should have experience working in a production environment and the ability to meet performance standards.
• Attention to detail and the ability to apply documented procedures to achieve desired outcomes are also required.
• MS Word and MS Excel, good interpersonal skills, written and oral communication abilities a must.
• A High School Diploma is required.
• Compensation and Benefits
• Competitive hourly rate commensurate with experience
• 100% remote work culture
• Health, dental & vision insurance
• Vacation and holiday pay
• Traditional and ROTH 401k with company match
• Company paid life insurance, AD&D, and long-term disability coverage
• HSA and FSA accounts
• Tuition Reimbursement
• Parental Leave
• Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.
• Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.