Claims Specialist

About the role

MediDrive is looking for a Claims Specialist to manage the accurate and timely processing of transportation claims within its Non‑Emergency Medical Transportation (NEMT) program. This remote position supports providers, ensures compliance with Medicaid rules, and helps maintain financial integrity of the program.

Key responsibilities

• Review and process transportation claims, verifying mileage, service level, eligibility, and required documentation.
• Validate claims against trip data, authorizations, and system records to meet billing requirements.
• Identify and resolve discrepancies, missing information, or errors before adjudication.
• Research and resolve denied, rejected, or pended claims, coordinating with internal teams and providers.
• Respond to provider inquiries regarding claim status, payments, and documentation.
• Maintain complete claim records for audit readiness and reporting.
• Ensure compliance with Medicaid regulations, HIPAA, and client contracts.
• Identify potential fraud, waste, and abuse indicators and escalate as needed.
• Track and report on claim metrics, recommending process improvements.

Required profile

• High school diploma or equivalent; associate or bachelor’s degree preferred.
• 2–4 years of experience in healthcare claims processing, billing, or related field.
• Familiarity with HCPCS, ICD‑9/ICD‑10, and condition codes is preferred.
• Experience in NEMT, Medicaid transportation, or healthcare operations is a plus.

Required skills

• HCPCS coding knowledge
• ICD‑9 coding knowledge
• ICD‑10 coding knowledge