Medicare Claims Specialist

Are you a detail-oriented and analytical individual with a passion for problem-solving? Do you enjoy working with emerging technologies and have a knack for creativity? If so, we may have the perfect opportunity for you at Barrow Wise Consulting, LLC.

We are seeking a highly skilled Medicare/Medicaid Claims Processor to join our team. As a key member of our Illinois DHS project, you will be responsible for reviewing incoming claims for completeness, accuracy, and adherence to Medicare and Medicaid guidelines. Your attention to detail and analytical abilities will ensure that claims are processed efficiently and accurately.

• Review incoming claims for completeness, accuracy, and adherence to Medicare and Medicaid guidelines
• Enter claim data into the system accurately, ensuring all required fields are populated
• Verify patient eligibility for Medicare and Medicaid coverage
• Confirm that services rendered are covered under the respective programs
• Assign appropriate diagnosis and procedure codes to claims
• Calculate reimbursement amounts based on fee schedules and program rules
• Process claims through automated systems
• Identify and resolve any claim errors, discrepancies, or missing information
• Communicate with providers, patients, and other stakeholders regarding claim status, denials, and appeals
• Collaborate with internal teams to address claim-related inquiries
• Assist in handling claim appeals, including gathering necessary documentation and submitting appeals to Medicare and Medicaid
• Track and monitor the progress of appeals
• Ensure compliance with federal and state regulations related to claims processing
• Maintain accurate records and documentation of claims activities
• Participate in quality control processes to prevent payment errors and fraud
• Identify trends or patterns in claims data for process improvement

• U.S. Citizenship
• Associate's Degree or Bachelor's degree
• 3 years of experience in healthcare claims processing, preferably with Medicare and Medicaid claims
• Knowledge and certification of ICD-10, CPT, and/or HCPCS coding
• Familiarity with claims adjudication software and electronic health records (EHR) systems
• Attention to detail and strong analytical abilities
• Excellent communication skills for interacting with providers and beneficiaries
• Ability to work independently and meet deadlines
• Understanding of healthcare billing and reimbursement processes
• Integrity and commitment to maintaining patient privacy
• Adaptability to changing regulations and guidelines
• Problem-solving mindset and customer service orientation

At Barrow Wise Consulting, LLC, we are dedicated to providing innovative solutions to our clients in an ethical and diverse work environment. We offer competitive compensation packages, excellent benefits, and opportunities for growth and advancement. Our team is committed to integrity, quality, innovation, and diversity, and we are confident that our core values, business model, and team focus create positive career paths for our employees.