ACO Medicaid Claims Review Specialist

Employer Industry: Healthcare

• Salary up to $24.79/hour
• Comprehensive benefits package including flexible work options
• Opportunity for career advancement and professional growth within the organization
• Remote work flexibility available from most U.S. states
• Supportive and collaborative work environment focused on member experience
• Recognition programs designed to celebrate contributions and support professional growth

• Review claims to ensure accurate coding, documentation, and compliance with billing regulations and payer guidelines
• Adjudicate claims to pay, deny, or pend as appropriate in a timely manner according to company policy
• Communicate and collaborate with external departments to resolve claims errors and issues
• Analyze and validate diagnosis codes (ICD-10) and procedure codes (CPT) on medical claims for accuracy
• Ensure medical claims include complete and accurate documentation supporting services rendered

• High School Diploma or Equivalent required
• At least 1-2 years of healthcare billing experience required
• Familiarity with Medicaid/ACO claims processing
• Strong attention to detail and accuracy in claim submissions and recordkeeping
• Excellent communication skills, both written and verbal

• Associate's Degree preferred
• Professional Coder (CPC) license preferred
• At least 2–4 years of experience in healthcare claims processing or billing highly preferred
• Strong working knowledge of managed care concepts and medical coding, including ICD-10, CPT, HCPCS, and Revenue Codes highly preferred
• Experience with core healthcare claims processing and billing systems highly preferred

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