Medicare Advantage Claims Processor

Job not on LinkedIn

🕒 August 24

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $18 - $20 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 42%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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RAM Technologies

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 1996

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

RAM Technologies is a U. S. -based manufacturer of high-reliability medical and industrial power supplies and related accessories. Since 1996 the company has designed and produced certified PC power supplies for medical devices and other industrial applications, emphasizing quick turnaround for prototypes, customizable output cables, and compliance with standards such as EN 60601-1. RAM Technologies offers long-life, warranty-backed products made in the USA, targeting OEMs and designers of medical and industrial electronics.

📋 Description

• Perform timely and accurate claim adjudication and adjustments • Adjudicate specialty claims, including ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), and institutional-based charges • Prepare encounters for submission and correct rejected encounters • Support system inquiries documented from member and provider call center services • Research and review Claims Appeals information to support client inquiries • Meet established production and quality standards • Identify opportunities to improve efficiency within assigned processes • Review pended claims of all types and specialties • Apply business rules and finalize claims in accordance with regulatory and client expectations • Review adjustment requests and determine whether to uphold original decisions or adjust claims • Assist with review and preparation of claims data for encounter submissions

🎯 Requirements

• 1-3 years in healthcare industry experience working in the payer segment in Medicare Advantage, Managed Medicaid, or working with an industry competitor • Experience in BPaaS environment is a plus • Experience working in a production environment • Ability to meet performance standards • Attention to detail • Ability to apply documented procedures to achieve desired outcomes • MS Word and MS Excel proficiency • Good interpersonal skills • Written and oral communication abilities • High School Diploma required • Compliance with company policies, security and privacy requirements, HIPAA, HITECH, and applicable federal and state regulations • Safeguarding PHI and PII in accordance with company policies and HIPAA regulations

🏖️ Benefits

• Competitive hourly rate commensurate with experience • 100% remote work culture • Health, dental & vision insurance • Vacation and holiday pay • Traditional and ROTH 401k with company match • Company paid life insurance, AD&D, and long-term disability coverage • HSA and FSA accounts • Tuition Reimbursement • Parental Leave