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Remote Medicare Claims Processing Jobs in Virginia

C-MCI

Medical Billing Specialist

Fairfax, VA · On-site +1

$18.50 - $24/hr

Remote / On-site Department: Revenue Cycle Management Overview: CMCI is seeking a detail-oriented ... claims processing, revenue cycle management, and contribute valuable insights to develop AI-powered ...

Imh

... remote position. Essential Functions * Oversees the day-to-day revenue cycle functions including claims processing, denials, payments, customer service, and follow up on accounts. Oversees ...

USAA

Sr. Injury Claims Adjuster

Chesapeake, VA · On-site +1

$63K - $121K/yr

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

USAA

Sr. Injury Claims Adjuster

Chesapeake, VA · On-site +1

$63K - $121K/yr

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

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All JobsMedicare Claims Processing JobsRemote Medicare Claims Processing JobsRemote Medicare Claims Processing Jobs in Virginia

Remote Medicare Claims Processing information

What is remote Medicare claims processing?

Remote Medicare claims processing involves reviewing, verifying, and submitting medical claims to Medicare from a location outside of a traditional office, often from home. Professionals in this role ensure that healthcare providers are reimbursed for services rendered to Medicare patients by checking claims for accuracy, compliance, and eligibility. They use specialized software to process electronic and paper claims, resolve discrepancies, and follow up on denied or delayed payments. This job requires knowledge of Medicare regulations, coding, and strong attention to detail. Remote work allows for flexible scheduling but also demands self-discipline and secure handling of sensitive patient data.

What are the key skills and qualifications needed to thrive as a remote Medicare claims processor?

To thrive as a Remote Medicare Claims Processor, you need strong attention to detail, knowledge of medical billing and coding, and a solid understanding of Medicare regulations, often supported by a relevant certification like CPC or CCA. Familiarity with claims processing software, electronic health record (EHR) systems, and Medicare-specific platforms such as the Fiscal Intermediary Standard System (FISS) is typically required. Strong organizational skills, effective written communication, and problem-solving abilities help you excel in remote work environments. These skills ensure timely and accurate claims processing, minimize errors, and support compliance with complex healthcare regulations.

What are some common challenges faced by remote Medicare claims processors and how can they be managed?

One common challenge for remote Medicare claims processors is staying up-to-date with frequent changes in Medicare regulations and billing codes. Additionally, working remotely can make it harder to quickly clarify complex cases with colleagues or supervisors. To manage these challenges, it's important to participate in regular training sessions, utilize internal communication platforms for collaboration, and maintain organized documentation. Employers often provide digital resources and support channels to help remote processors stay connected and informed.

What is the difference between Remote Medicare Claims Processing vs Remote Medical Billing Specialist?

AspectRemote Medicare Claims ProcessingRemote Medical Billing Specialist
CertificationsCPAR, CPC, or similarCPB, CPC, or similar
Work EnvironmentHealthcare insurance, government programsHealthcare providers, clinics, hospitals
Job FocusSubmitting and managing Medicare claimsBilling for various medical services and insurance

Remote Medicare Claims Processing involves handling claims specifically for Medicare, focusing on government regulations and Medicare-specific procedures. Remote Medical Billing Specialists manage billing for a variety of insurance types and healthcare providers. While both roles require similar certifications and work remotely in healthcare settings, Medicare Claims Processing is specialized in government insurance claims, whereas Medical Billing covers broader insurance billing tasks.

What are the most commonly searched types of Medicare Claims Processing jobs in Virginia?

The most popular types of Medicare Claims Processing jobs in Virginia are:

What are popular job titles related to Remote Medicare Claims Processing jobs in Virginia?

For Remote Medicare Claims Processing jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Remote Medicare Claims Processing jobs in Virginia look for?

The top searched job categories for Remote Medicare Claims Processing jobs in Virginia are:

What cities in Virginia are hiring for Remote Medicare Claims Processing jobs?

Cities in Virginia with the most Remote Medicare Claims Processing job openings:

Remote Medicare Claims Processing jobs near you
Infographic showing various Remote Medicare Claims Processing job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 21% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Sr. Medical Economics Analyst

Ennoble Care

Arlington, VA • Remote

Full-time

Posted yesterday

New

Ennoble Care rating

4.2

Company rating: 4.2 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

About Us

Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, "To Care is an Honor." Join Ennoble Care today!

Position Overview

We are seeking an experienced Sr. Medical Economics Analyst to join our value-based care (VBC) team in our Accountable Care Organization (ACO). This role requires a seasoned professional with 3-5 years of data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes.

Key Responsibilities

Risk Assessment & Medicare Analytics

  • Develop and maintain sophisticated risk-adjusted provider group performance models using CMS-HCC methodology.
  • Analyze VBC performance under various CMS and CMMI total cost-of-care models.
  • Monitor and forecast financial performance across assigned patient populations.
  • Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets, including simulating CMS-HCC risk adjustment.

Data Management & Analytics

  • Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
  • Ensure data quality and integrity across all analytical processes.

Business Intelligence & Reporting

  • Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
  • Develop executive dashboards and performance metrics aligned with organizational strategic goals.
  • Present findings and recommendations to leadership teams and clinical stakeholders.
  • Support budget planning and financial forecasting processes.

Regulatory Compliance & Process Improvement

  • Stay current with evolving CMS and CMMI program requirements and quality measures.
  • Collaborate with revenue cycle and coding teams to optimize documentation and billing accuracy.
Required Qualifications

Education & Certification

  • Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration or related quantitative field

Experience Requirements

  • 3-5 years of data analytics experience, preferably in healthcare or Medicare-focused environments
  • Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
  • Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs
  • Proven track record analyzing Medicare claims data, specifically CCLF and BCDA datasets
  • In-depth knowledge of healthcare billing processes from both provider and CMS perspectives

Technical Proficiency

  • Advanced proficiency in Microsoft Excel (pivot tables, complex formulas, VBA preferred)
  • Strong SQL skills with ability to write complex queries and optimize database performance
  • Experience with Microsoft Azure cloud platform and related analytics tools
  • Proven ability to work with very large datasets (multi-million row files) and combine data from multiple sources
  • Experience integrating EHR data with claims datasets for comprehensive population health analysis

Core Competencies

  • Exceptional analytical and problem-solving capabilities
  • Strong business acumen with the ability to translate technical findings into strategic recommendations
  • Excellent written and verbal communication skills for both technical and non-technical audiences
  • Proven team player with a collaborative approach to cross-functional projects
  • Demonstrated capability to understand and respond to evolving business needs

Location: Fully Remote (with up to 10% travel)

This position requires the ability to work with sensitive healthcare information and maintain strict confidentiality in accordance with HIPAA and other applicable regulations.

Full-time employees qualify for the following benefits:

  • Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.
  • Paid Time Off
  • Paid Office Holidays

All employees qualify for these benefits:

  • Paid Sick Time
  • 401(k) with up to 3% company match
  • Referral Program
  • Payactiv: pay-on-demand. Cash out earned money when and where you need it!

Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended.

Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.

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