Senior Claims Specialist

Job Summary

A company is looking for a Senior Claims Specialist (Clinical Appeals and Denials).

Key Responsibilities

• Confirm eligibility and authorization requirements for Medicaid patients and submit authorization requests
• Coordinate with hospitals and physicians to complete Medicaid enrollment applications and manage compliance with guidelines
• Perform payment reconciliation and ensure timely payment from Medicaid payers

Qualifications and Requirements

• High School Diploma or GED
• 2-3 years of related experience in the healthcare industry or a related area
• Working knowledge of ICD9, CPT codes, HIPAA, HCPCS, and Medicaid preferred
• Required computer skills, including data entry and proficiency in MS Office applications
• Remote positions require a home internet connection that meets specific criteria