Job Description
Job Description
We are currently seeking a Claims Processing Coordinator for a fully remote, temporary full-time position through October. This role is with a mission-driven organization that provides essential healthcare services to seniors. We're looking for a qualified candidate who can start as soon as possible.
- Job Title: Claims Processing Coordinator
- Reports to: Director of Health Plan Administration
- Job Type: Full-Time, Contract (through October 2025)
- Work Schedule: Monday-Friday, Day Shift (40 hours/week)
- Start Time: 7:00 AM, 7:30 AM, or 8:00 AM EST (flexible start time available)
- Location: Fully Remote (equipment provided)
Position Summary:
The Claims Processing Coordinator is responsible for overseeing and coordinating claims-related operations including in-house claims adjudication, authorizations, eligibility reporting, and subrogation. This position ensures processes are compliant with state and federal regulations and supports the organization's mission to assist older adults in maintaining their dignity and independence.
Key Responsibilities:
- Uphold the mission and values of our company and the PACE model of care.
- Coordinate timely adjudication of claims within 30 days of receipt. Monitor claim volume, distribute work, and ensure resolution of pended claims.
- Review and verify claim payments processed outside of the claims system, entered by a Claims Processing Specialist.
- Manage the claims appeals process:
- Log and review appeals.
- Collaborate with Medical Director on clinical denials.
- Respond in writing to providers within 30 days.
- Oversee Coordination of Benefits (COB) and subrogation for Medicare Part A/B claims.
- Collaborate with interdisciplinary teams (IDT) and the Health Plan Data Analyst to ensure accurate claims processing.
- Process weekly check runs:
- Review claim vouchers for accuracy.
- Handle refunds and voided checks.
- Provide payment data to the Finance department.
- Develop and conduct audits to ensure accuracy of claims and authorizations.
- Manage Excess Loss Reinsurance reporting:
- Track high-cost claims and catastrophic cases.
- Work with Medical Director to compile and submit reports to reinsurers.
- Address escalated provider complaints and unresolved inquiries.
- Serve as the primary liaison with the Claims Processing System (CPS) vendor:
- Review documentation and troubleshoot errors.
- Test and implement upgrades in collaboration with IT.
- Perform ongoing system maintenance including updates to profiles, vendors, and providers.
- Review and correct CMS encounter data rejections due to processing errors.
- Prepare and audit monthly membership files for accuracy.
- Generate reports for internal teams on demand or as part of regular operations.
- Educate and support Health Plan staff on claim issues and system errors.
- Provide backup coverage for Health Plan team roles as needed.
- Perform additional duties as assigned.
If you are interested in this opportunity, we encourage you to apply! We will be conducting interviews ASAP!
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.
Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?
Company Description
Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?