Remote Medicare/Medicaid Claims Analyst II

CoventBridge Integrity; United States; Remote; USD 50,000 - 55,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Life, LTD and STD paid by employer

401(k) with company match

Job summary

CoventBridge Integrity is seeking a Claims Analyst II for a remote role. You will review Medicare/Medicaid claims, re-pricing overpayments, and support Medical Review during fraud investigations.

A strong grasp of medical terminology and coding principles is essential, with daily pre-pay edit tracking and reporting responsibilities. The role reports to the Medical Review Project Manager and may work from a home office if not local to Grove City, OH.

Qualifications

• Extensive knowledge of medical terminology and coding principles.
• Knowledge of Medicare and Medicaid guidelines and coverage.
• Ability to read Medicare and Medicaid claims (paper and electronic).
• Experience with pricing and payment systems in Medicare/Medicaid.
• Strong communication skills and ability to work independently.

Responsibilities

• Maintain workflow balance to ensure re-pricing requests are completed on time.
• Use medical terminology and coding principles in re-pricing claims.
• Complete assignments meeting quality goals for accuracy.
• Implement and track pre-pay edit requests daily.
• Prepare monthly pre-pay savings reports.
• Move claims to UPIC safe locations when records are received.
• Adjudicate DME pre-pay decisions in VMS.
• Facilitate daily adjudication of pre-pay claims based on MR review decisions.
• Scan, review, and file Medical Review records and documents.
• Enter key information into Excel spreadsheets.
• Attend required education and training programs.
• Follow confidentiality and HIPAA guidelines.
• Perform other duties to meet UPIC goals and CMS directives.

Skills

Medical terminology

Coding principles

Medicare rules

Medicaid rules

MS Office

Verbal and written communication

Independent work

Attention to detail

Education

High School Diploma or GED

CPC certification preferred

Tools

Excel

Job description

CoventBridge Integrity is seeking a Claims Analyst II for a remote role. You will review Medicare/Medicaid claims, re-pricing overpayments, and support Medical Review during fraud investigations.

A strong grasp of medical terminology and coding principles is essential, with daily pre-pay edit tracking and reporting responsibilities. The role reports to the Medical Review Project Manager and may work from a home office if not local to Grove City, OH.