NEMT Medical Claims Specialist - Remote

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Requirements:

• Bachelor's degree or equivalent experience.
• 2+ years of experience in healthcare or medical claims processing or a related role.
• Demonstrable high degree of proficiency in spreadsheet software.
• Meticulous attention to detail and accuracy.
• Strong ability to work independently and manage time effectively.
• Excellent analytical and problem-solving skills.
• Comfortable collaborating in a fast-paced environment.
• Strong communication skills, both written and verbal.
• Preferred experience: OfficeAlly, third-party administrator portals (e.g., WPS), Looker.

Responsibilities:

• Review and process NEMT claims submissions, ensuring accuracy and completeness.
• Track and correct rejected as well as denied claims within timely filing period.
• Utilize business intelligence tools (e.g., Looker) to analyze data and generate reports related to claims processing and performance metrics.
• Navigate and manage third-party administrator portals and aggregation tools to track claims status and resolve discrepancies.
• Collaborate with internal teams and external partners to facilitate timely claims resolution.
• Maintain accurate records and documentation for all claims activities.
• Conduct regular audits to identify areas for process improvement and ensure compliance with regulations.
• Provide exceptional customer service to clients and stakeholders regarding claims inquiries.
• Continuously identify opportunities for process improvements, automation, and enhanced efficiency within the accounting function.