Medicare/Medicaid Claims Processor - Remote | WFH

Do you enjoy problem-solving, expressing your creativity, and exploring emerging technologies? If so, this opportunity is perfect for you. As a multi-disciplined leader, you'll have the chance to showcase the unique skills that set you apart from the rest. Join us and bring innovative solutions to our clients.

Responsibilities

As a Medicaid/Medicare Claims Processor supporting our Illinois DHS project, you will:

Review Claims: Ensure incoming claims are complete, accurate, and compliant with Medicare and Medicaid guidelines.

Data Entry: Accurately enter claim data into the system, ensuring all required fields are populated.

Eligibility Verification: Confirm patient eligibility for Medicare and Medicaid coverage.

Coverage Confirmation: Ensure services rendered are covered under respective programs.

Coding: Assign appropriate diagnosis and procedure codes to claims.

Reimbursement Calculation: Calculate reimbursement amounts based on fee schedules and program rules.

Automated Processing: Process claims through automated systems.

Error Resolution: Identify and resolve claim errors, discrepancies, or missing information.

Stakeholder Communication: Communicate with providers, patients, and other stakeholders about claim status, denials, and appeals.

Team Collaboration: Work with internal teams to address claim-related inquiries.

Appeal Handling: Assist in handling claim appeals, including gathering necessary documentation and submitting appeals to Medicare and Medicaid.

Appeal Tracking: Track and monitor the progress of appeals.

Compliance: Ensure compliance with federal and state regulations related to claims processing.

Documentation: Maintain accurate records and documentation of claims activities.

Quality Control: Participate in quality control processes to prevent payment errors and fraud.

Process Improvement: Identify trends or patterns in claims data for continuous improvement.

Remote Work: Enjoy the flexibility of working remotely.

Ideal Candidate

The ideal candidate will have:

U.S. Citizenship

Associate's or Bachelor's degree

3 years of experience in healthcare claims processing, particularly with Medicare and Medicaid claims

Certification and knowledge of ICD-10, CPT, and/or HCPCS coding

Familiarity with claims adjudication software and electronic health records (EHR) systems

Attention to detail and strong analytical abilities

Excellent communication skills for interacting with providers and beneficiaries

Ability to work independently and meet deadlines

Understanding of healthcare billing and reimbursement processes

Commitment to maintaining patient privacy

Adaptability to changing regulations and guidelines

A problem-solving mindset and a customer service orientation

Why Join Us?

Become Part Of a Team Dedicated To Providing Innovative Solutions To Clients In An Ethical And Diverse Work Environment. We Offer

Competitive compensation packages

Excellent benefits

Opportunities for growth and advancement

A welcoming environment for Minority/Female/Disabled/Protected Veteran/LGBTQ+ candidates

Our core values are integrity, quality, innovation, and diversity. We believe these values, along with our business model and team focus, create positive career paths for our employees. Join us and be a part of leading the industry in delivering new solutions and ensuring client satisfaction.

Employment Type: Full-Time