Remote Medical Claims processing

Guidehealth; Nashville (TN); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company in healthcare is seeking an experienced auditor to ensure compliance and accuracy in claims processing. The ideal candidate will have a background in healthcare or managed care, with strong analytical skills and attention to detail. This role offers remote work flexibility and a supportive environment focused on professional growth and development.

Benefits

Remote work flexibility

Comprehensive health plans

401(k) with 3% employer match

Life and disability insurance

Employee Assistance Program (EAP)

Flexible Time Off

Paid parental leave

Resources for professional growth

Qualifications

• Minimum 3 years in healthcare or managed care, including claims/reimbursement.
• 1-3 years of healthcare industry auditing experience.

Responsibilities

• Ensure compliance with client contract criteria and requirements.
• Perform targeted audits of claims processing and contract logic.
• Conduct quality audits of claims staff and eligibility staff.

Skills

Problem-solving

Effective communication

Organized

Detail-oriented

Team player

Education

Bachelor’s degree in healthcare informatics

Bachelor’s degree in business administration

Tools

Microsoft Office

Eldorado HealthPac Claims system

Job description

Job Description

WHAT YOU’LL BE DOING

• Understand and stay current with client contract criteria and requirements, ensuring client services are compliant and meet client expectations.
• Ensure accuracy of claims processing and contract logic through internal audit processes.
• Perform targeted audits of claims processing, including high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims.
• Conduct quality audits of claims staff, eligibility staff, and system logic.
• Audit new client setup in the claims processing software.
• Run access queries as needed for administrative purposes.
• Perform other duties and responsibilities as assigned.

Qualifications:

WHAT YOU'LL NEED TO HAVE

• Minimum 3 years of experience in healthcare or managed care, including claims/reimbursement, analytics, and project management experience.
• 1-3 years of healthcare industry auditing experience.
• Proficiency in Microsoft Office, especially Word, Excel, and Access.
• Problem-solving skills, initiative, and ability to make low to medium-level decisions.
• Understanding of current healthcare compliance requirements.
• Ability to meet deadlines, prioritize, analyze data, and work independently or in a team.
• Organized, self-motivated, detail-oriented, professional, and a team player.
• Effective communication skills.

WOULD LOVE FOR YOU TO HAVE

• Bachelor’s degree in healthcare informatics, business administration, or related field, or equivalent experience and education.
• Certified Professional Coder (strongly recommended).
• Experience with Eldorado HealthPac Claims system is a plus.
• Claims coding, coding edits, and APC pricing knowledge.
• CPT and ICD coding knowledge.

Additional Information

The base pay range for this role is between $21-$24 per hour, paid bi-weekly

All information will be kept confidential according to EEO guidelines.

ALIVE with Purpose: How We Thrive at Guidehealth

Our values include accountability, continuous growth, collaborative innovation, valuing every voice, and empathy in action, which define our culture and approach.

BENEFITS:

• Remote work flexibility.
• Comprehensive health plans.
• 401(k) with 3% employer match.
• Life and disability insurance.
• Employee Assistance Program (EAP).
• Flexible Time Off.
• Paid parental leave.
• Resources for professional growth.

COMPENSATION:

Paid bi-weekly; final pay depends on experience, skills, education, location, and certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

We promote diversity and inclusion and do not discriminate based on protected classifications.

OUR COMMITMENT TO PROTECTION OF PATIENT AND COMPANY DATA

Follow all security policies to protect PHI, PII, and intellectual property.

REMOTE WORK TECHNICAL REQUIREMENTS

Employees need reliable internet (minimum 50 Mbps download, 10 Mbps upload) and equipment provided by Guidehealth.