Remote Medical Claims Eligibility Specialist II | WFH

Job Overview

We are seeking an experienced Medical Claims Eligibility Specialist to become an integral member of our innovative team. In this essential role, you will contribute significantly to our claims adjudication process, evaluating claims data to ascertain eligibility in strict compliance with federal regulations and our internal protocols.

Key Responsibilities

• Examine Explanation of Benefits (EOB) and payment remittance documentation to pinpoint claims qualified for dispute resolution.
• Compose correspondence that adheres to regulatory requirements and internal standards, ensuring both clarity and accuracy.
• Collaborate with healthcare providers and health plans through email correspondence to obtain critical information and provide updates on claim statuses, utilizing various operating systems.
• Stay informed on industry regulations to develop and implement effective strategies.
• Organize and maintain electronic files for all claims deemed eligible.
  
  

Required Skills

• Expertise in reviewing a diverse array of medical claims, EOBs, and payment remittances.
• Familiarity with insurance reimbursement guidelines.
• Exceptional attention to detail and the capacity to perform at a high level consistently.
• Proficiency in navigating multiple operating systems comfortably.
• Strong dedication to confidentiality and professionalism in all circumstances.
• Outstanding written and verbal communication skills, with the ability to articulate reasoning effectively.
  
  

Qualifications

• A Bachelor’s degree is mandatory.
• A minimum of 2 years of experience in healthcare claims analysis is essential.
• Preferred: Billing and Coding Certification.
  
  

Career Growth Opportunities

We offer a flexible remote working arrangement following an initial 1-2 week in-office training period, allowing for an ideal work-life balance while maintaining high performance standards.

Company Culture And Values

As a reputable healthcare management group with over 20 years of industry experience, we are committed to cost control and regulatory compliance. Our team is dedicated to providing exceptional administrative and medical expert services to enhance healthcare quality across the nation. Join us in our mission to positively impact the healthcare landscape.

Employment Type: Full-Time