Medical Claims Processor-Remote

About the position

The Medical Claims Processor position is a remote contract role focused on processing medical claims efficiently and accurately. The role requires adherence to company regulations, including HIPAA compliance, and emphasizes the importance of meeting productivity and quality targets. The ideal candidate will have experience in medical claims processing and familiarity with VBA or HRP systems.

Responsibilities

• Processing of Professional claim forms files by provider
• Reviewing the policies and benefits
• Complying with company regulations regarding HIPAA, confidentiality, and PHI
• Abiding by the timelines to complete compliance training of NTT Data/Client
• Working independently to research, review and act on the claims
• Prioritizing work and adjudicating claims as per turnaround time/SLAs
• Ensuring claims are adjudicated as per clients defined workflows, guidelines
• Sustaining and meeting the client productivity/quality targets to avoid penalties
• Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA
• Timely response and resolution of claims received via emails as priority work
• Correctly calculating claims payable amount using applicable methodology

Requirements

• 2+ years of experience in medical claims processing
• 1+ year of experience with VBA or HRP
• High school diploma or GED

Nice-to-haves

• 1+ year of experience with HealthRules

Benefits

• Remote work flexibility
• Competitive hourly wage of $18 - $22
• Opportunity for contract extension based on performance