Medical Claims Processor

Job Summary

To support a remote team, the part-time Medical Claims Processor will manage the accurate entry, review, and resolution of medical claims while ensuring compliance with CMS guidelines and client-specific policies.

Key responsibilities

• Review medical claims to ensure completeness and accuracy of information
• Navigate multiple systems to research and process claims, verifying pricing and prior authorizations
• Determine claim payments or denials and complete necessary documentation for denied claims

Required qualifications

• Minimum of one year of recent experience processing medical claims for a health insurance company or payer
• Familiarity with medical claim forms (CMS-1500 and UB-04)
• Working knowledge of coding systems: ICD-10, HCPCS, and CPT
• Proficient in Microsoft Windows and Excel (advanced functions)
• High School Diploma or equivalent