Medicare/Medicaid Claims Processor - Remote | WFH - Get It Recruit - Healthcare
Potomac, MD 20850
About the Job
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
Salary: $ 40,000.00 60,000.00 Per Year
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
Salary: $ 40,000.00 60,000.00 Per Year
Source : Get It Recruit - Healthcare