Medicare Claims Processor

📋 Description

• Review, analyze, and process Medicare insurance claims in accordance with CMS guidelines
• Determine appropriate claim outcomes, including whether claims should be paid, denied, or returned
• Verify the accuracy of data entry and maintain complete and accurate claim and member records.
• Analyze claims to determine the extent of insurance carrier liability and establish appropriate
• Resolve claim edits, review member and claim history, and determine eligibility for specific
• Review payment levels and supporting information to reach accurate final payment determinations.

🎯 Requirements

• Associate degree in a related healthcare field, or a high school diploma/equivalent combined with
• At least 1 year of Medicare claims processing experience.
• At least 1 year of experience working with CMS requirements and professional and UB/institutional
• At least 1 year of customer service experience.
• Bachelor’s degree in medical coding or a related healthcare field is preferred, or 4 years of
• Three years of Medicare claims processing experience is preferred.

🎁 Benefits

• Full-time schedule of 40 hours per week.
• Remote work opportunity within the United States.
• Opportunity to contribute to Medicare claims operations supporting healthcare access and accurate
• Collaborative environment with opportunities to work across claims, customer service, and
• Professional training and development to build proficiency in claims processes, systems, and
• Exposure to Medicare, CMS requirements, professional and institutional claims, and healthcare