Medical Claims Processor II

Broadway Ventures LLC; United States; Remote; USD 45,000 - 65,000; Full time

Job summary

A healthcare consulting firm is seeking a Medical Claims Processor to join their team. The ideal candidate will have over 5 years of experience in processing complex medical claims with strong attention to detail and excellent communication skills. This remote position requires familiarity with ICD-10 and healthcare insurance procedures. The role offers various benefits, including health insurance and flexible paid time off.

Benefits

401(k) with employer matching

Health insurance

Vision insurance

Life insurance

Flexible Paid Time Off (PTO)

Paid Holidays

Qualifications

• Minimum of five years of experience in medical claims processing.
• Familiarity with ICD-10, CPT, and HCPCS coding systems.
• Strong problem-solving capabilities and a customer service-oriented mindset.

Responsibilities

• Analyze and process complex medical claims ensuring accuracy.
• Collaborate with internal departments to resolve discrepancies.
• Maintain confidentiality of patient records in accordance with HIPAA.

Skills

Attention to detail

Critical thinking

Problem-solving

Communication skills

Education

High school diploma or equivalent

Tools

Microsoft Office Suite

Job description

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply.

Work Schedule

• Remote
• Monday through Friday, 8:30 AM to 5:00 PM EST
• Must be able to work 8am - 5pm Eastern Standard Time

Responsibilities

• Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.
• Critical Analysis: Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios.
• Timely Processing: Ensure prompt claims processing to meet client standards and regulatory requirements; identify and resolve barriers using effective problem-solving strategies; collaborate with internal departments to proactively resolve discrepancies; use analytical skills to identify root causes and implement solutions.
• Confidentiality Maintenance: Uphold confidentiality of patient records and company information in accordance with HIPAA regulations.
• Detailed Record Keeping: Maintain thorough and accurate records of claims processed, denied, or requiring further investigation.
• Trend Monitoring: Analyze and report trends in claim issues or irregularities to management; assist Team Leads with reporting to contribute to continuous process improvements.
• Audit Participation: Engage in audits and compliance reviews to ensure adherence to internal and external regulations; critically evaluate and recommend process improvements when necessary; mentor and train new claims processors as needed.

Requirements

• High school diploma or equivalent.
• Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. Billing experience doesn't count towards years of experience qualification.
• Familiarity with ICD-10, CPT, and HCPCS coding systems.
• Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker’s compensation claims is a plus).
• Strong attention to detail and accuracy.
• Ability to interpret and apply insurance program policies and government regulations effectively.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Ability to work independently and collaboratively within a team environment.
• Commitment to ongoing education and staying current with industry standards and technology advancements.
• Experience with claim denial resolution and the appeals process.
• Ability to manage a high volume of claims efficiently.
• Strong problem-solving capabilities and a customer service-oriented mindset.
• Flexibility to adjust to the evolving needs of the client and program changes.
• Benefits include: 401(k) with employer matching, Health insurance, Vision insurance, Life insurance, Flexible Paid Time Off (PTO), Paid Holidays.

What to Expect Next

Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Equal Employment Opportunity Statement

Broadway Ventures is an equal-opportunity employer. We comply with applicable laws ensuring equal opportunity in the workplace for all employees and applicants.