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Remote Medicare Claims Processing Jobs in Rochester, NY

Kodak

Workers Compensation Manager

Rochester, NY · On-site +1

$85K - $100K/yr

Candidates seeking remote or hybrid work arrangements must have the ability and willingness to ... Ongoing communication for the purpose of claims investigations and strategy development with Kodak ...

Lantern

Strategy Analyst

Rochester, NY · Remote

... process. Job Overview The Strategy Analyst / Associate is a high-visibility, hands-on, and dynamic ... This is a remote-first role with occasional (~1x month) travel. Responsibilities and Duties:

Lantern

Strategy Analyst

Geneseo, NY · Remote

... process. Job Overview The Strategy Analyst / Associate is a high-visibility, hands-on, and dynamic ... This is a remote-first role with occasional (~1x month) travel. Responsibilities and Duties:

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All JobsRemote Medicare Claims Processing JobsRemote Medicare Claims Processing Jobs in Rochester, NY

Remote Medicare Claims Processing information

See Rochester, NY salary details

$11

$22

$33

How much do remote medicare claims processing jobs pay per hour?

As of May 28, 2026, the average hourly pay for remote medicare claims processing in Rochester, NY is $22.04, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $25.14 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Medicare Claims Processor, and why are they important?

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 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 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 popular job titles related to Remote Medicare Claims Processing jobs in Rochester, NY? For Remote Medicare Claims Processing jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Remote Medicare Claims Processing jobs in Rochester, NY look for? The top searched job categories for Remote Medicare Claims Processing jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Remote Medicare Claims Processing jobs? Cities near Rochester, NY with the most Remote Medicare Claims Processing job openings:
Remote Medicare Claims Processing jobs near you

Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)

Passport Health Plan by Molina Healthcare

Rochester, NY • Remote

Full-time

Posted 7 days ago

Job description

JOB DESCRIPTION Job Summary

Provides lead level analyst support for health plan payment integrity activities.  Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy.  Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.

Essential Job Duties

Business Leadership & Operational Ownership
Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.

  • Analyze data to identify and develop new recovery opportunities
    • Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines
    • Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
    • Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.
  • Responsible for documenting policies and procedures related to concept approvals
    • Conduct trainings and prepare training documentation for teams
    • Other duties as assigned

Strategic Business Analysis
Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.

Applied Analytical Support
Uses data analysis tools/systems to support business analysis.
Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
Creates succinct summaries and visualizations that enable faster leadership decision-making.
 

Required Qualifications

At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
Strong data analysis/queries experience, and ability to analyze data to inform business decisions.  
Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
Strong written and verbal communication skills, including ability to synthesize complex information.
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency. 

  • Claims processing background
  • Experience with Medicare, Medicaid, and/or Marketplace lines of business.
  • Payment integrity (PI) programs
     

Preferred Qualifications

Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
Project management experience.
Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.
 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $83,252 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

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