Medical Claims Processor VA
A senior claims processor who reviews, validates and processes medical claims accurately and on time, whether you are a billing company submitting them or a payer or TPA adjudicating them. Backlogs clear, errors drop and turnaround targets are met.
- Top 1% vetted talent
- No lock-in contracts
- Replacement guarantee
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Hourly rates · No lock-in contracts
Description
A Medical Claims Processor VA reviews, validates and processes healthcare claims for billing companies, payers or TPAs. They can check eligibility and coding information, resolve suspended claims, apply benefit rules and maintain complete processing records. Outsource Teams provides top 1% vetted talent with medical claims processing experience, no lock-in contracts and a replacement guarantee, helping teams reduce backlogs and maintain consistent turnaround and accuracy.
Responsibilities
- Review incoming claims (CMS-1500 and UB-04, paper and EDI 837) for completeness, valid codes, provider details and patient eligibility.
- Adjudicate or prepare claims according to plan benefits, contracted rates, coding rules and the client's processing guidelines.
- Work pended and suspended claims, request missing information from providers or members, and resolve edits within service level targets.
- Apply coordination of benefits, duplicate checks and timely-filing rules correctly before approving or releasing a claim.
- Process adjustments, reversals and reprocessing requests with a clear audit trail.
- Reconcile 835 remittances and EOBs, identifying underpayments and overpayments for follow-up.
- Meet daily production and accuracy targets, typically 98 percent or better on financial and procedural accuracy.
- Identify recurring error patterns from providers or systems and raise them for correction.
- Document every action in the claims system and maintain HIPAA compliance across all claim data.
- Support internal and external audits by pulling claim histories and explaining processing decisions.
Software & Tools
Requirements
- At least 5 years of medical claims processing or adjudication experience with a payer, TPA, BPO or medical billing company.
- Working knowledge of CPT, ICD-10-CM, HCPCS, revenue codes, modifiers and EDI 837 and 835 transactions.
- Experience with claims platforms such as Facets, QNXT, HealthEdge, Epic Tapestry or a major billing system.
- Understanding of US plan types, benefit structures, coordination of benefits and Medicare and Medicaid rules.
- Fast, accurate keyboarding and a documented record of meeting production and quality targets.
- Good written English for provider correspondence and notes, and clear spoken English for team calls.
- HIPAA training completed.
- Stable high-speed internet with backup power, available during the client's US business hours.
Frequently Asked Questions
What types of claims can they process?
They can work with CMS-1500 and UB-04 claims, including both paper and EDI transactions.
Can they work suspended or incomplete claims?
Yes. They can request missing information, resolve edits and process adjustments or reprocessing requests with a documented audit trail.
What systems can they use?
They can work with Waystar, Availity, Kareo, AdvancedMD and Microsoft Excel.
How experienced are the candidates?
Candidates are expected to have at least five years of medical claims processing or adjudication experience.
How much does it cost?
Rates are listed in USD at $7 per hour for entry-level talent, $9 per hour for intermediate and $12 per hour for senior talent. Both full-time and part-time options are available.
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