Claims Specialist

Corporate Transportation Group•Denver, CO

6h•Onsite

About The Position

MediDrive is seeking a Claims Specialist to support the accurate and timely processing of transportation claims within the Non-Emergency Medical Transportation (NEMT) program. This role is responsible for reviewing, validating, and processing claims in accordance with MediDrive policies, state Medicaid requirements, and client-specific guidelines. The Claims Specialist plays a critical role in ensuring financial accuracy, resolving claim discrepancies, and supporting transportation providers with claims-related inquiries.

Requirements

High school diploma or equivalent required
2–4 years of experience in healthcare claims processing, billing, or related field.
Proficient in Microsoft Office Suite (Excel, Word, Outlook)
Typing speed of 35+ words per minute

Nice To Haves

associate or bachelor’s degree preferred
Working knowledge of HCPCS, ICD-9/ICD-10, and condition codes preferred.
Experience in NEMT, Medicaid transportation, or healthcare operations preferred.

Responsibilities

Review and process transportation claims, ensuring accuracy of mileage, level of service, eligibility, and required documentation.
Validate claims against trip data, authorizations, and system records to ensure compliance with billing requirements.
Identify discrepancies, missing information, or errors and take appropriate action to resolve prior to adjudication.
Research and resolve denied, rejected, or pended claims by identifying root causes and coordinating with internal teams or transportation providers.
Respond to transportation provider inquiries related to claims status, payments, and documentation requirements.
Support the resolution of claims disputes through detailed review of system data and supporting documentation.
Assist in validating claims prior to payment and ensure accurate explanation of payment (EOP) documentation.
Maintain accurate and complete claims records to support audit readiness and reporting requirements.
Ensure proper documentation is retained in accordance with MediDrive policies and regulatory standards.
Ensure all claims processing activities comply with Medicaid regulations, HIPAA requirements, and client-specific contractual obligations.
Identify potential fraud, waste, and abuse (FWA) indicators and escalate concerns as appropriate.
Maintain a high level of accuracy and productivity to meet established performance standards and turnaround times.
Track and support reporting on claims metrics such as processing volume, turnaround time, and denial trends.
Identify recurring issues and recommend process improvements to enhance efficiency and reduce errors.
Collaborate with Operations, Customer Service, and Finance teams to improve claims workflows and outcomes.
Participate in special projects and perform other duties as assigned.