Medicare Claims Specialist II - Remote

WPS—A health solutions company; Missouri; Remote; USD 22,000 - 31,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) with generous match

Paid time off

Health and dental insurance from day 1

Telehealth services

Professional development programs

Job summary

WPS—A health solutions company is seeking a Claims Rep 2 to process Medicare claims from receipt to resolution, ensuring accuracy, timely handling, and strong customer service. Training occurs Monday–Friday, CT; afterwards, a flexible 8-hour shift window between 6am–6pm CT with remote work options in approved states.

Ideal candidates have 1+ year in hospital/clinic billing, data-entry proficiency, and the ability to multitask in a fast-paced environment, while maintaining HIPAA/privacy

Qualifications

• High School Diploma or GED or equivalent experience.
• One or more years of experience in hospital, clinic and/or medical office billing.
• One or more years of post-high school education or coursework in insurance or medical-related studies.
• Demonstrated proficiency in data entry with accuracy.
• Ability to multitask, prioritize, problem-solve, and adapt to a fast-paced environment.
• Ability to work independently and meet quality and production standards.

Responsibilities

• Review Medicare Part A and Part B claims using federal guidelines to ensure proper processing.
• Handle complex adjustments including reconsiderations and patient complaints.
• Communicate with internal departments, providers, and members to obtain information.
• Interact with providers by phone to resolve pending claim problems and coordinate with CMS contractors.
• Assist department in meeting CMS performance metrics and quality standards.
• Provide backup for staff duties and stay current with regulations and coding standards.
• Ensure compliance with privacy, ISO 9000, FOI and confidentiality requirements.

Skills

Data entry

Multitask

Prioritize

Problem-solve

Fast-paced environment

Independent work

Education

High school diploma or GED

Post-high school coursework in insurance/medical studies

Job description

WPS—A health solutions company is seeking a Claims Rep 2 to process Medicare claims from receipt to resolution, ensuring accuracy, timely handling, and strong customer service. Training occurs Monday–Friday, CT; afterwards, a flexible 8-hour shift window between 6am–6pm CT with remote work options in approved states.

Ideal candidates have 1+ year in hospital/clinic billing, data-entry proficiency, and the ability to multitask in a fast-paced environment, while maintaining HIPAA/privacy