Medicare Claims Specialist - Remote, Flexible Hours

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

Benefits offered by this job

Remote work options available

Performance bonus and/or meritIncrease

401(k) with a 100% match for the first

Competitive paid time off

Health insurance, dental insurance, и/

Job summary

WPS—A health solutions company is seeking a Claims Rep 2 to process Medicare claims from receipt through resolution in accordance with applicable policies, procedures, and regulatory requirements, ensuring timely and accurate resolution while maintaining high quality and customer service.

This role offers an hourly pay of at least $19.00, remote work eligibility in approved states, and a training period Monday–Friday 7:30am–4:00pm CT.

Qualifications

• High School Diploma or GED or equivalent experience.
• One (1) 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, and experience in a position using computer, keyboarding, and customer communications.
• Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy.
• Ability to multitask, prioritize, problem-solve, and effectively 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 including complex and specialty claims, by applying federal and internal guidelines to ensure appropriate application of processing guidelines, payment rules, and manual calculation procedures.
• Handle complex adjustments involving multiple admissions and adjustments regarding pending returned notices. Manually adjust reconsideration, including patient complaints and denials, and process through the system accordingly.
• Communicate with internal departments, healthcare providers, and members to obtain additional information or clarify claim issues.
• Interact with providers by phone to resolve pending claim problems. Correspond with providers, other contractors, and QIOs on various claim-related problems.
• Assist department in meeting CMS performance metrics and minimum quality and quantity standards.
• Support Claims department and provide back-up for completing staff responsibilities as needed.
• Keep up to date with changes in regulations, coding standards, and plan policies.
• Meet requirements of Federal Privacy Act, International Organization of Standards (ISO 9000), Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality.

Skills

Data entry

Multitasking

Attention to detail

Customer communications

Education

High School Diploma

Post-secondary education in insurance/medical studies

Job description

WPS—A health solutions company is seeking a Claims Rep 2 to process Medicare claims from receipt through resolution in accordance with applicable policies, procedures, and regulatory requirements, ensuring timely and accurate resolution while maintaining high quality and customer service.

This role offers an hourly pay of at least $19.00, remote work eligibility in approved states, and a training period Monday–Friday 7:30am–4:00pm CT.