Remote Medicare Claims Specialist

Jobgether; United States; Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Remote work within the United States

40 hours per week

Professional training and development

Job summary

Jobgether partners with a Medicare health plan to hire a Medicare Claims Processor based in the United States. This full-time remote role supports accurate adjudication of Medicare claims, applying CMS guidelines, benefits provisions, and organizational policies.

You will review eligibility, claim history, edits, and payment levels to determine outcomes, while maintaining PHI/HIPAA confidentiality and collaborating with internal and external partners.

Qualifications

• At least 1 year of Medicare claims processing experience.
• Experience with CMS requirements and professional/institutional claims.
• Strong knowledge of Medicare terminology and HIPAA.
• Excellent data entry and confidentiality.

Responsibilities

• Review, analyze, and process Medicare claims per CMS guidelines.
• Determine outcomes: pay, deny, or request more information.
• Verify data entry accuracy and maintain records.
• Resolve claim edits and determine eligibility for services.
• Communicate with internal and external partners to resolve issues.
• Maintain confidentiality of PHI and HIPAA compliance.

Skills

Medicare claims processing

CMS guidelines

Data entry accuracy

Customer service

EPIC software

Education

Associate degree in healthcare

Bachelor's degree in medical coding or related field (preferred)

Tools

EPIC software

EHR systems

Job description

Jobgether partners with a Medicare health plan to hire a Medicare Claims Processor based in the United States. This full-time remote role supports accurate adjudication of Medicare claims, applying CMS guidelines, benefits provisions, and organizational policies.

You will review eligibility, claim history, edits, and payment levels to determine outcomes, while maintaining PHI/HIPAA confidentiality and collaborating with internal and external partners.