What are the responsibilities and job description for the Healthcare Claims Specialist position at RealREPP?
Remote or Philadelphia, PA (Preference for experienced candidates over location)
$55,000 – $75,000 Bonus Eligible
About The Role
RealREPP is partnering with a growing healthcare organization that is bringing key claims and reimbursement functions in-house. We are seeking a Healthcare Claims Specialist with strong Medicare claims processing experience to join their team. This is a great opportunity to work with an established leader in the industry while also having room for career growth!
Key Responsibilities
$55,000 – $75,000 Bonus Eligible
About The Role
RealREPP is partnering with a growing healthcare organization that is bringing key claims and reimbursement functions in-house. We are seeking a Healthcare Claims Specialist with strong Medicare claims processing experience to join their team. This is a great opportunity to work with an established leader in the industry while also having room for career growth!
Key Responsibilities
- Review, analyze, and process Medicare and hospital claims to ensure compliance with reimbursement policies.
- Support contract negotiation and payment scale interpretation to ensure proper claim adjudication.
- Work with fee schedules, DRG pricing methodologies, and reimbursement models to improve payment accuracy.
- Assist in the No Surprises Act (NSA) appeals process and Independent Dispute Resolution (IDR) cases.
- Utilize claims processing systems (experience with Javelina, FACETS, Epic, or similar is a plus).
- Collaborate with internal teams to identify repricing errors and resolve contract discrepancies.
- 3 years of experience in healthcare claims processing, repricing, or Medicare billing.
- Knowledge of Medicare Fee Schedules, DRG methodologies, and hospital contracts.
- Proficiency in Microsoft Excel and data analysis for claims-related reporting.
- Experience with contract negotiation, claims adjudication, and reimbursement analysis.
- Familiarity with Javelina or other claims pricing systems is a plus.
- Strong attention to detail and ability to read and interpret contracts.
- $55,000 – $75,000 base salary performance bonuses
- Full benefits package, including:
- Medical, dental, and vision coverage (PPO and HSA options)
- 401(k) with company match
- Telemedicine services at $0 copay
- Dependent care flexible spending account
- Robust voluntary benefits, including life insurance and disability coverage
- Career growth opportunities within a rapidly expanding department
Salary : $55,000 - $75,000
