Remote Claims Specialist - Medicare & Medicaid

Globalhealth Holdings; Oklahoma City (OK); Hybrid; USD 25,000 - 36,000; Full time

Job summary

GlobalHealth is seeking a Claims Processor to handle all types of contracted and non-contracted claims for Medicare, Medicaid and Commercial insurance. The role requires independent work with strong customer service and communication skills in a remote environment.

Responsibilities include processing claims per guidelines, coordinating with management on pended claims, assisting with adjustments, and maintaining confidentiality of PHI under HIPAA.

Qualifications

• Must have full understanding of insurance processes (Managed Care, Medicare, Medicaid and Commercial practices).
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of Medicare and Health Care Finance Administration regulations.
• Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs and authorizations/referrals.
• Ability to read and interpret provider contracts.
• Strong verbal, written and organizational skills, must be self-directed/self-motivated and must have analytical, problem-solving, and decision-making abilities.
• Accurate keyboard skills.
• Ability to function in a fast-paced, detail-oriented environment.
• Basic math skills.
• High degree of accuracy.
• Team player.

Responsibilities

• Processes claims based on the productivity and quality standard set (HCFA1500 and UB92) per day in accordance with contractual and non-contractual agreements and processing guidelines.
• Works with Claims Supervisor or Manager in review of processed and pended claims to ensure appropriate, timely and accurate claims processing.
• Coordinates with Claims Manager on resolution of customer service inquiries within 24 hours of receipt.
• Assist with Claims adjustment projects as requested.
• May help with Claims entry when requested.
• Completes various work assignments as requested by supervisor in a timely manner.
• Maintains current desk procedures and reference materials.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

Skills

Insurance processes

Claims processing knowledge

Medicare/Medicaid regulations

EOBs and medical codes

Provider contracts interpretation

Verbal and written communication

Keyboarding/computer typing

Attention to detail

Team player

Education

High School diploma or equivalent

Job description

GlobalHealth is seeking a Claims Processor to handle all types of contracted and non-contracted claims for Medicare, Medicaid and Commercial insurance. The role requires independent work with strong customer service and communication skills in a remote environment.

Responsibilities include processing claims per guidelines, coordinating with management on pended claims, assisting with adjustments, and maintaining confidentiality of PHI under HIPAA.