Remote Medicare Claims Examiner – D-SNP (CA)

TEKsystems; Irvine (CA); Remote; USD 39,000 - 42,000; Full time

Benefits offered by this job

100% Remote

Contract with extension possible

Job summary

TEKsystems is seeking a Medicare Claims Examiner (D-SNP) for a fully remote contract role. California residents only, with hands-on QNXT experience, and a background in Medicare/Medi-Cal claims processing will excel.

Responsibilities include reviewing and adjudicating claims, researching pended/denied D-SNP cases, maintaining CPT/HCPCS/ICD coding documentation, and ensuring CMS compliance. Strong analytical skills and the ability to work independently in a remote, production-driven environment

Qualifications

• 3+ years of Claims Examiner or healthcare claims processing experience.
• Medicare and/or Medi-Cal claims processing experience.
• D-SNP (Dual Eligible Special Needs Plan) experience.
• Health plan experience.
• Strong understanding of claims adjudication and payment determination.
• Experience working in a high-volume production environment.
• Knowledge of CPT, HCPCS, ICD, and HCFA coding.
• Medical terminology knowledge.
• Strong analytical, organizational, and communication skills.
• Ability to work independently in a remote environment.
• Proficiency with Microsoft Office and claims processing systems.

Responsibilities

• Review, research, price, and process paper and electronic claims.
• Research and resolve pended and denied D-SNP claims.
• Determine claim payment eligibility and adjudicate claims.
• Review manual review and audit reports.
• Maintain documentation related to CPT, HCPCS, ICD, and HCFA coding.
• Ensure compliance with Medicare, Medi-Cal, CMS, and health plan guidelines.
• Communicate with internal departments regarding claim issues and resolutions.
• Identify trends and support process improvement efforts.
• Meet productivity, quality, and turnaround-time expectations.

Skills

Medicare claims processing

D-SNP experience

High-volume production

Communication skills

Analytical skills

Remote work capability

Tools

QNXT

MS Office

Job description

TEKsystems is seeking a Medicare Claims Examiner (D-SNP) for a fully remote contract role. California residents only, with hands-on QNXT experience, and a background in Medicare/Medi-Cal claims processing will excel.

Responsibilities include reviewing and adjudicating claims, researching pended/denied D-SNP cases, maintaining CPT/HCPCS/ICD coding documentation, and ensuring CMS compliance. Strong analytical skills and the ability to work independently in a remote, production-driven environment