Top 44 Claims processor medicare Jobs

Claims Auditor- Remote
American Health Plans —Franklin, TN
- Remote
- Mid-level
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
Certified Claims Processor I
AllCare Health —Grants Pass, OR
- $20 - $24 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Health insurance
- 401(k)
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Experienced Medical Claims Processor
90 Degree Benefits —Charlotte, NC
- $18 - $21 an hour
- Full-time
- Hybrid work
- Computer literacy
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Sr. Manager Claims (Remote)
American Medical Association —Chicago, IL
- $104,872 - $138,737 a year
- Remote
- 7 years
- Writing skills
- HIPAA
- Disability insurance
10d
Utilization Management Clinical Dental Processor
Avesis, Incorporated —Remote
- $18.33 - $35.84 an hour
- Overtime
- Microsoft Outlook
- Writing skills
- Mid-level
- Paid parental leave
- Disability insurance
5d
Medical Claims COB Processor I
Moda Health —Milwaukie, OR
- $18.39 - $20.58 an hour
- Weekends as needed
- Word processing
- High school diploma or GED
- Continuous improvement
- Paid holidays
- Health insurance
Quick Apply
Medical Claims Processor
Turning Point Recovery Center of New Mexico —Albuquerque, NM
- Full-time
- Mid-level
- Office
- Finance
- Health insurance
- Dental insurance
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Associate, Claims Receipt Processor
Ametros Financial —Wilmington, MA
- $20 - $23 an hour
- Full-time
- Hybrid work
- High school diploma or GED
- Organizational skills
- Communication skills
10d
Hospital Claims Processor
Choice Medical Group —Apple Valley, CA
- $20 - $25 an hour
- Full-time
- Computer literacy
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Medical Biller
Hope Christian Health Center Corp —North Las Vegas, NV
- $19.75 - $25.50 an hour
- Full-time
- Spanish
- Word processing
- English
Quick Apply
Medical Content Analyst, Specialist (Pre-Pay Policy)
Lyric —Pennsylvania
- $125,241 - $187,862 a year
- Full-time
- Remote
- Nursing
- Mid-level
- 3 years
Billing-Post Claims Insurance Follow Up Processor
Superior Ambulance Service —Albuquerque, NM
- $16 - $17 an hour
- Part-time
- Customer service
- Office
- Criminal background check
- Health insurance
- Dental insurance
Quick Apply
5d
Patient Services Supervisor - Hospital Billing and Follow Up (Open & Promotional)
County of San Mateo —San Mateo, CA
- $94,432 - $118,040 a year
- Full-time
- Hospital
- Word processing
- Basic math
- Retirement plan
MSO CLAIMS MANAGER
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $112,247.20 - $128,752.00 a year
- Full-time
- 5 years
- Analysis skills
- Children
- Health insurance
- Dental insurance
Government Programs Appeal Coordinator I
Moda Health —Milwaukie, OR
- $21.30 - $23.96 an hour
- Overtime
- Hybrid work
- Writing skills
- Research
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
Billing Processor
CODAC HEALTH RECOVERY & WELLNESS INC —Tucson, AZ
- Full-time
- Bilingual
- Microsoft Access
- Computer literacy
Director, Revenue Division
Sutter Health —Emeryville, CA
- $187,886.40 - $300,622.40 a year
- Weekends as needed
- Up to 50% travel
- Writing skills
- 8 years
- Work from home
Business Intelligence Developer-Medicaid - Level I (Remote AZ)
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Computer science
- Bachelor of Science
- Mid-level
Medical Biller I
HEALTH ADVOCATES —Chatsworth, CA
- $21.75 - $28.00 an hour
- Full-time
- HIPAA
- Mid-level
- Office
- Health insurance
- Employee assistance program
Claims Manager
Advanced MSO —El Centro, CA
- $65,000 - $78,000 a year
- Part-time
- Hybrid work
- 5 years
- HIPAA
- Finance
- Paid holidays
- Paid time off
Quick Apply
7d

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Claims Auditor- Remote

American Health Plans -
Franklin, TN

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Job Details

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
Referral program

Qualifications

Medicare
Managed care
Managed care organization experience
CMS
Regulatory compliance in claims processing
Medical claims processing software
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid
Quality audits
Insurance (Financial sectors)
Healthcare claims compliance audits
Audit support
Healthcare coding compliance audits

Full Job Description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com (https://amhealthplans.com/).

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleMedicine 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts
Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
Work assigned claim projects to completion
Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
Maintain production and quality standards as established by management
Participate in and support ad-hoc audits as needed
Other duties as assigned

JOB REQUIREMENTS:

Proficient in processing/auditing claims for Medicare and Medicaid plans
Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
Current experience with both Institutional and Professional claim payments
Knowledge of automated claims processing systems
Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

Experience:
- Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
- Two (2) years’ experience in managed healthcare environment related to claims processing/audit
- Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
- Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
- Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
License/Certification(s):
- Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

claims processor medicare jobs

Claims Auditor- Remote

Certified Claims Processor I

Experienced Medical Claims Processor

Sr. Manager Claims (Remote)

Utilization Management Clinical Dental Processor

Medical Claims COB Processor I

Medical Claims Processor

Associate, Claims Receipt Processor

Hospital Claims Processor

Medical Biller

Medical Content Analyst, Specialist (Pre-Pay Policy)

Billing-Post Claims Insurance Follow Up Processor

Patient Services Supervisor - Hospital Billing and Follow Up (Open & Promotional)

MSO CLAIMS MANAGER

Government Programs Appeal Coordinator I

Billing Processor

Director, Revenue Division

Business Intelligence Developer-Medicaid - Level I (Remote AZ)

Medical Biller I

Claims Manager

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