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Medicaid Claims Processing Remote information

What are the key skills and qualifications needed to thrive as a Medicaid claims processing remote professional?

To thrive in a Medicaid Claims Processing Remote role, you need a solid understanding of medical billing, coding, and Medicaid regulations, typically supported by experience in healthcare administration or claims processing. Familiarity with claims management software, medical coding systems (such as ICD-10 or CPT), and electronic data interchange (EDI) platforms is essential. Strong attention to detail, organizational skills, and effective communication are crucial soft skills for accuracy and collaboration. These skills ensure timely and accurate processing of claims, compliance with regulations, and effective resolution of claim issues in a remote environment.

What is Medicaid claims processing remote?

Medicaid Claims Processing Remote refers to the job of reviewing, analyzing, and processing Medicaid insurance claims from a location outside of a traditional office, often from home. Professionals in this role ensure that claims are accurate, complete, and comply with Medicaid regulations before approving or denying payment. Remote workers use specialized software to access claim information securely and may communicate with healthcare providers and patients to gather additional details. This job requires attention to detail, knowledge of Medicaid policies, and the ability to work independently. Remote claims processors play a crucial role in ensuring the timely and accurate reimbursement of healthcare services for Medicaid recipients.

What are some common challenges faced in a remote Medicaid claims processing position, and how can they be managed?

Working remotely as a Medicaid Claims Processor can present challenges such as staying up-to-date with changing regulations, maintaining attention to detail when reviewing large volumes of claims, and ensuring secure handling of sensitive patient data. To manage these challenges, it's important to regularly participate in team training sessions, utilize checklists or claim management software to minimize errors, and follow strict data security protocols. Open communication with supervisors and colleagues through virtual platforms also helps in resolving complex claims and staying connected with team goals.
What are the most commonly searched types of Medicaid Claims Processing jobs in Indiana? The most popular types of Medicaid Claims Processing jobs in Indiana are:
What are popular job titles related to Medicaid Claims Processing Remote jobs in Indiana? For Medicaid Claims Processing Remote jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Medicaid Claims Processing Remote jobs in Indiana look for? The top searched job categories for Medicaid Claims Processing Remote jobs in Indiana are:
What cities in Indiana are hiring for Medicaid Claims Processing Remote jobs? Cities in Indiana with the most Medicaid Claims Processing Remote job openings:
Medicaid Claims Processing Remote jobs near you
Infographic showing various Medicaid Claims Processing Remote job openings in Indiana as of August 2026, with employment types broken down into 86% Full Time, 7% Part Time, and 7% Contract. Highlights an 100% Remote job distribution.

Coder Specialist - Remote

Beacon Health System

Granger, IN • On-site, Remote

Full-time

Re-posted 2 days ago

Beacon Health System rating

6.7

Company rating: 6.7 out of 10

Based on 143 frontline employees who took The Breakroom Quiz

531st of 887 rated healthcare providers

Job description

Reports to the Manager, Coding & Records. Reviews, codes, and analyzes medical records in order to abstract relevant data from patient medical records into the on-line computer system. Assigns DRGs to Medicare, Medicaid, and other required payors. Determines DRG and APC assignment on outpatient and inpatient records. Maintains productivity and accuracy levels for the assigned job code.
This is a remote position; however, candidates must reside in one of the following states: Indiana, Michigan, Illinois, Kansas, Ohio, Georgia, Kentucky, Florida, Idaho, Minnesota, Tennessee, Wisconsin, Colorado, South Carolina, North Carolina, or Texas.
MISSION, VALUES and SERVICE GOALS
  • MISSION: We deliver outstanding care, inspire health, and connect with heart.
  • VALUES: Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Reviews and analyzes discharged patient medical records to ensure all applicable patient data is available for coding and abstracting by:
  • Checking the diagnosis and procedure to ensure accurate coding and sequencing as specified by established coding principles and guidelines, following AHA, AHIMA, and CMS coding guidelines for outpatient and inpatient records.
  • Obtaining accurate and complete patient data through the review of the medical record, discharge summary, history and physical, consultation, progress notes, laboratory, radiology, operative and pathology reports.
  • Coding all procedures on inpatient records (all payors) and outpatient surgical records according to ICD-9-CM Codes, CPT-4 or Physician E&M (Evaluation & Management) Level Code (as applicable).
  • Referring questionable diagnoses and sequencing issues to the physician for clarification.
  • Communicating with the Patient Accounts staff and coordinating with department Manager any questionable abstract or coding problems.
  • Assigning ICD-9-CM Codes and completing a coding summary.
  • Reviewing and evaluating error messages and all incompatible DRGs to the manager or coordinator for a second level review.
  • Completing medical records for abstracting. Resolving any medical necessity related issues.

Completes medical record data entry duties by:
  • Abstracting diagnosis and procedure codes into the Hospital computer system according to specified guidelines.
  • Designating APC assignment on outpatient medical records.
  • Assigning accurately, when applicable, a DRG or APC to Medicare, Medicaid and other required payor's records with the assistance of various computerized grouper software.
  • Abstracting professional E&M codes, professional procedure codes, and technical component procedures into the Hospital computer system charging module according to specified guidelines.
  • Accurate and timely entry of charges on ED and OBS charts according to guidelines if applicable.

Ensures accurate and up-to-date coding by:
  • Quarterly internal and external auditing.
  • Reviewing Coding Clinic and attending coding workshops to enhance coding skills.
  • Billing software edits.
  • For the coding of diagnostic reports, a productivity standard of 250 reports is to be met and medical necessity holds resolved (based upon an 8 hour work day).
  • For the coding of inpatient, ambulatory surgery/observations and emergency records, one of the following productivity standards must be met (all include data entry and are based upon an 8 hr work day):
  • Inpatient Records: Certified Specialist (greater than 25)
  • Ambulatory Surgery/Observation Records: Cert Spec (greater than 60)
  • Emergency Records Facility Records: Certified Specialist (greater than 90)
  • Emergency Records Professional Records: Certified Specialist (100-120)

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
  • Completing other job-related duties and projects as assigned.
ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license/certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience
  • The knowledge, skills and abilities as indicated below are normally acquired through the successful attainment of certification as a CCS (Certified Coding Specialist), and maintenance of the certification is required. Designation as a Certified Specialist requires the completion of course work in medical terminology, anatomy, physiology and comprehensive knowledge of ICD-9-CM and CPT-4 coding principles. Attainment of certification as either RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist-Physician), CPC (Certified Professional Coder), or CPC-H (Certified Professional Coder-Hospital) as well as knowledge and training in more than two work types. Three years of inpatient coding and/or CPT ambulatory surgery coding experience and the ability to mentor and train other coders is required. Three years advanced medical and surgical coding experience in a large acute care facility is preferred.

Knowledge & Skills
  • Requires knowledge of medical terminology, anatomy and physiology necessary to code patient medical records utilizing established but specialized technical coding processes.
  • Requires knowledge of the fundamentals of DRG assignment and optimization.
  • Requires knowledge of state and federal regulatory guidelines for reimbursement in the prospective payment system in order to interface with physicians.
  • Requires the analytical skills to compile and process patient information abstracted from patient records.
  • Requires familiarity with computer data entry.
  • Requires accurate typing skills of at least 40 w.p.m.
  • An accuracy rate of 92% for inpatient and outpatient records is required for the Level I and II position. An accuracy rate of 95% for inpatient and outpatient records is required for the Coding Specialist position.
  • Demonstrates the interpersonal and communication skills (both verbal and written) necessary to interact with staff, physicians, and others.

Working Conditions
  • Works in an office environment.
  • May experience some mental/visual fatigue from careful and constant review of records, code books, and continued use of computer equipment.

Physical Demands
  • Requires the physical ability, motor coordination and stamina to perform the essential functions of the position.

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