Medical Claims Specialist — Make a Difference

Wellpath; Franklin (TN); Presencial; USD 45.000 - 60.000; Tempo integral

Benefícios oferecidos por esta vaga

DailyPay

Tuition Assistance

Employee Assistance Program (EAP)

Health Spending Accounts (HSA)

Wellness program

Banking partnership

Resumo da vaga

Wellpath / Correct Care Solutions is seeking a Claims Specialist to ensure accurate and timely medical claim processing based on established rules, coding standards, payer guidelines, and regulatory requirements.

You will review and resolve denials, communicate with internal teams and providers, and maintain high productivity with quality service while supporting a mission-driven healthcare environment focused on underserved populations.

Qualificações

• High school diploma or GED required.
• 3-5 years of medical claims processing experience required.
• Working knowledge of CPT/HCPCS and ICD-10 coding standards.
• Familiarity with CMS guidelines and regulations.
• Strong customer service and communication skills.
• Proficiency in the Microsoft Office Suite (Outlook, Word, Excel).
• High level of attention to detail with strong organizational skills.

Responsabilidades

• Analyze, verify, and process medical claims to determine accurate payment or denial based on established rules and rates.
• Review claim data, coding, documentation, edits, and pended reports to ensure completeness and compliance.
• Resolve claim denials, rejections, and payment discrepancies through detailed analysis and follow-up.
• Communicate with internal teams, providers, payers, and Claims Leadership to address claim-related issues and barriers.
• Maintain productivity, quality, and turnaround standards while providing courteous and responsive customer service.

Conhecimentos

Claims processing

CPT/HCPCS ICD-10

CMS guidelines

Customer service

MS Office

Formação

High school diploma or GED

Ferramentas

Microsoft Word

Microsoft Excel

Outlook

Descrição da vaga

Wellpath / Correct Care Solutions is seeking a Claims Specialist to ensure accurate and timely medical claim processing based on established rules, coding standards, payer guidelines, and regulatory requirements.

You will review and resolve denials, communicate with internal teams and providers, and maintain high productivity with quality service while supporting a mission-driven healthcare environment focused on underserved populations.