Medicare Advantage Claims Processor - 100% remote

At RAM Health , our mission is to simplify the complexities of healthcare administration through innovative, technology-driven solutions. With a focus on changing the industry one plan at a time, we drive continuous innovation to help government-sponsored health plans improve performance and quality while reducing costs. RAM Health - Health plan administration, simplified. This position is fully remote and open to U.S. candidates. The Claims / Encounter Specialist will be required to perform reviews of pended claims of all types and specialties, apply business rules and finalize claims in accordance with regulatory and client expectations. Additionally, the Specialist will review adjustment requests and determine whether to uphold the original decision or perform an adjustment of the claim to correct outcomes. This role will also be required to assist with review and preparation of claims data for submission of encounters. The specialist must have excellent analytical skills, along with keen attention to detail and good written and oral communication abilities. Responsibilities: Perform timely and accurate claim adjudication and adjustments Adjudicate specialty claims, including, but not limited to ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges. Prepare encounters for submission and correct rejected encounters Support system inquiries