Remote Jobs
Remote Provider Reimbursement and Claims Specialist
What's your preference?
Job Description
- Req#: 249555
Employer Industry: Healthcare Benefits Organization
Why consider this job opportunity:
- Salary of $20.80 per hour
- Comprehensive benefits package including health, dental, vision, and life insurance
- Paid time off to support work-life balance
- Opportunity for career advancement and potential contract extension
- Supportive and collaborative work environment focused on team culture
- Chance to make a significant impact on claims processing and reimbursement accuracy
What to Expect (Job Responsibilities):
- Conduct detailed manual review and pricing of claims, especially out-of-network or non-standard claims
- Interpret hospital and provider contracts to determine payment methodologies and reimbursement rates
- Manage claim pend queue inventory and ensure compliance with regulatory requirements
- Review claims for correct coding and adherence to claims policies
- Investigate and resolve complex claim edits independently, making informed decisions on claim payments
What is Required (Qualifications):
- Must be knowledgeable in CMS guidelines for pricing
- 2-3 years of claims pricing or billing experience
- Demonstrated experience in manually reviewing and pricing claims, including interpreting provider contracts
- Hands-on experience with claims processing systems
- Knowledge of CPT/HCPCS, ICD-10 claims coding, and medical terminology
How to Stand Out (Preferred Qualifications):
- Experience with complex claims and non-standard payment methodologies
- Familiarity with User Acceptance Testing (UAT) of provider contracts
- Strong analytical skills to identify and resolve issues within claims processing
- Background in medical claims procedures and adjudication processes
- Ability to work independently on claims-related projects with minimal supervision
#Healthcare #ClaimsProcessing #RemoteWork #CareerGrowth #InsuranceIndustry
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
The best remote jobs for you
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.