Medicaid Claims Resolution Specialist

Wipro Ltd.; United States; Remote; USD 32,000 - 34,000; Full time

Benefits offered by this job

Medical & dental benefits

Disability insurance

Paid time off

Leave options

Job summary

Infocrossing INC is seeking a Data Entry Resolutions Specialist to maintain accuracy in Medicaid claims processing. You will resolve suspended MO HealthNet claims and attachments through evaluation and data entry in the eMMIS system.

You will analyze exception pages, coordinate with medical consultants, and explain determinations to providers, while updating EOB codes and staying current with Medicaid policy changes. This role supports operational excellence within BPS-IHS.

Qualifications

• Strong analytical skills and attention to detail.
• Experience evaluating claims and attachments for approval or denial.
• Ability to stage claims for clinical review.
• Knowledge of Medicaid policies and audits.

Responsibilities

• Analyze exception test pages to determine claim status.
• Coordinate with medical consultants for staged reviews.
• Explain determinations to healthcare providers.
• Document resolutions using EOB codes in the eMMIS platform.

Skills

Data analysis

Attention to detail

Regulatory compliance

Provider communication

Medicaid policy knowledge

Tools

eMMIS system

Job description

Infocrossing INC is seeking a Data Entry Resolutions Specialist to maintain accuracy in Medicaid claims processing. You will resolve suspended MO HealthNet claims and attachments through evaluation and data entry in the eMMIS system.

You will analyze exception pages, coordinate with medical consultants, and explain determinations to providers, while updating EOB codes and staying current with Medicaid policy changes. This role supports operational excellence within BPS-IHS.