Medicare Claims Resolution Specialist — Remote

Sarnova HC, LLC; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

Digitech is seeking a Medicare Account Resolution Specialist to manage Medicare claims after submission, ensuring accurate and timely processing. This role requires sharp analytical skills and attention to detail in a fast-paced billing environment.

The ideal candidate will navigate Medicare guidelines, handle denials and follow-up, maintain precise documentation, and communicate clearly with internal teams to support timely payments.

Qualifications

• Education: High School Diploma or equivalent required.
• Strong computer skills with MS Outlook, Word, and Excel.
• Ability to type a minimum of 40 WPM with accuracy.
• Proven ability to manage high-volume workloads while meeting strict deadlines.
• Experience in an environment with call monitoring, productivity metrics, or performance scoring is preferred.
• Ability to remain calm, professional, and effective during phone interactions while maintaining a positive company image.
• Excellent written and verbal communication skills, with the ability to explain information clearly and professionally.
• High attention to detail with strong accuracy in claim review and documentation.
• Strong organizational and time-management skills with the ability to prioritize work and complete assigned tasks efficiently.
• Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment.

Responsibilities

• Work Medicare claims that are pending, unable to be released, denied, or paid incorrectly, ensuring each claim is resolved appropriately and returned to payment status.
• Review and resolve claims placed on hold by identifying the reason for the hold, correcting errors, and completing all required follow‑up actions.
• Analyze Medicare denials to determine accuracy, identify next steps, and complete appeals, adjustments, or resubmissions as needed.
• Provide Medicare with any additional documentation or information necessary for accurate claim adjudication.
• Prepare, process, and track correspondence such as letters, emails, supporting documents, and required refunds.
• Maintain detailed and accurate notes, documentation, and workflow updates within billing systems to support claim progression and audit requirements.

Skills

MS Outlook

MS Word

MS Excel

Typing 40 WPM

Attention to detail

Time management

Communication skills

Remote work

Education

High School Diploma

Job description

Digitech is seeking a Medicare Account Resolution Specialist to manage Medicare claims after submission, ensuring accurate and timely processing. This role requires sharp analytical skills and attention to detail in a fast-paced billing environment.

The ideal candidate will navigate Medicare guidelines, handle denials and follow-up, maintain precise documentation, and communicate clearly with internal teams to support timely payments.