Remote Medicare Claims Specialist II: Expert Resolution

WPS—A health solutions company; Colorado; 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 match up to 3% and 2%

Competitive PTO

Health insurance and telehealth start

Professional development

Job summary

WPS—A health solutions company in the United States is seeking a Claims Rep 2 to process Medicare claims from receipt through resolution while applying CMS rules and internal procedures to ensure accurate, timely results.

You will handle complex adjustments, communicate with providers and members, and support CMS performance goals. This role offers remote options within approved states and training before transitioning to scheduled shifts.

Qualifications

• High School Diploma or GED.
• 1+ year experience in hospital, clinic and/or medical office billing.
• Post-high school education or coursework in insurance or medical-related studies.
• Proficiency in data entry with accuracy.
• Ability to multitask and adapt in a fast-paced environment.
• Ability to work independently and maintain quality 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, ISO 9000, FOIA, and confidentiality.

Skills

Data entry

Multitasking

Communication

Attention to detail

Independent work

Education

High School Diploma or GED

Clinical/insurance related coursework

Tools

UB CMS-1450 (CMS-1450)

HCFA CMS-1500

Job description

WPS—A health solutions company in the United States is seeking a Claims Rep 2 to process Medicare claims from receipt through resolution while applying CMS rules and internal procedures to ensure accurate, timely results.

You will handle complex adjustments, communicate with providers and members, and support CMS performance goals. This role offers remote options within approved states and training before transitioning to scheduled shifts.