Customer Care Medicare/ Medicaid Claims Processing Specialist

Industry Knowledge:

  • 5+ year experience processing and adjudicating Medicaid and Medicare claims including:
  • Billing and Coding Edits (CPT/ICD-10/HCPCS/ Modifiers)
  • Third Party Liability COB (Coordination of Benefits) filing rules
  • Third Party Liability Carrier Codes
  • CPT Codes/HCPCS Codes
  • 999 files
  • 837s (format used by health care professionals and suppliers to transmit health care claims electronically)
  • Understanding of the billing resubmission process
  • Timely filing
  • Researching rejected claims
  • Remittance advice
  • Proper use of modifiers with procedure codes
  • Claim Adjustment Group Code (Group Code)
  • Claim Adjustment Reason Code (CARC)
  • Remittance Advice Remark Code (RARC)
  • Detailed knowledge of electronic billing processes and universal billing forms (UB04, HCFA 1500)
  • Knowledge of the appeal process to government payers



  • A strong working knowledge of Microsoft office products
  • Excellent verbal and written communication and interpersonal skills
  • Strong analytical and critical thinking skills with a high attention to detail
  • Must be able to be flexible in a fast pace environment and adaptable to change
  • Ability to work independently as well as with all levels of staff, leadership and external partners and vendors
  • Ability to read, comprehend and apply governmental rules and regulations
  • Ability to effectively prioritize, coordinate and lead activities
  • Able to talk and work with providers and their staff:
  • Experience calling, documenting, and following up with Providers
  • Need to be very organized and able to maintain juggling many balls all at once
  • Microsoft Excel experience a plus
  • Promptly and professionally respond to emails


Job Requirements:

  • Associates degree preferred
  • Minimum of five years’ experience in healthcare claims processing, or combination of education, training and experience preferably for home healthcare in a Medicaid / Medicare environment
  • Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.
  • Deliver exceptional customer service consistently to every customer.
  • Strong communication, analytical, and problem solving skills
  • Adequate written skills to accurately complete required documentation within the time frames prescribed
  • Knowledge of medical terminology; standard claim forms and physician billing coding;
  • Ability to self-manage in a fast-paced, detail-oriented environment
  • Excellent data entry skills are required

  • Drop files here or
    Accepted file types: doc, docx, pdf, txt.