Claims Processing Specialist - Medical Insurance (Remote)

Overview

The Claims Processing Specialist is responsible for handling medical insurance claims, ensuring compliance with Medicare coding and billing regulations, and providing support and education to providers.

In Short

• Remote position with full-time employment.
• Requires a minimum of 5 years experience in claims auditing, billing, and/or coding.
• Acts as a subject matter expert on provider billing and reimbursement.
• Responds to post-payment inquiries from providers.
• Processes and reviews claims to ensure payment integrity.
• Identifies trends through auditing and internal reporting.
• Develops educational resources for providers.
• Participates in coding and billing conferences and workshops.
• Maintains effective working relationships with providers.
• Analyzes claims processes for potential areas of fraud and waste.

Requirements

• High School degree required; Bachelor's degree preferred.
• CPC, CPC-P, or equivalent preferred.
• In-depth knowledge of Medicare coding and billing requirements.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Strong written and verbal communication skills.
• Ability to articulate complex regulatory information clearly.
• Experience with ICD-10, CPT-4, and HCPC coding principles.
• Extensive knowledge of Medicare regulations and policies.
• Ability to develop and present reports of findings.
• Proficiency in auditing and claims processing.

Benefits

• Competitive compensation and benefits package.
• Medical, dental, and vision coverage starting on day one.
• Retirement savings account with employer match.
• Generous paid time off programs.
• Tuition/professional development reimbursement.
• Employee recognition programs.
• Relocation assistance available.
• DailyPay option for eligible colleagues.
• Opportunities for diversity, equity, and inclusion engagement.
• Equal opportunity employer committed to diversity and inclusion.