Remote Inpatient Claims Processor

Introduction to the Role

Are you passionate about precision, healthcare innovation, and digital workflows? As a Remote Inpatient Claims Processor, you will be part of a fast-paced, technology-driven team dedicated to revolutionizing how medical claims are handled. This role combines clinical expertise with analytical acumen, positioning you as a key player in ensuring the financial integrity of healthcare providers. In a landscape where digital operations are reshaping patient services, your attention to detail will directly contribute to streamlining reimbursement cycles. We’re looking for individuals who thrive in remote work environments, excel at interpreting medical documentation, and find satisfaction in transforming data into action. With an annual salary of $41,265, this position offers both stability and forward momentum in a growing industry. You’ll join a distributed team committed to innovation, empowered by automation, and driven by measurable outcomes. This opportunity is ideal for someone seeking meaningful work within a virtual yet vibrant healthcare tech ecosystem.

Key Responsibilities

• Review and process inpatient claims with a focus on documentation accuracy and compliance.
• Analyze diagnosis codes, length of stay, discharge summaries, and DRG groupings to verify claim integrity.
• Ensure each claim complies with payer-specific protocols by utilizing integrated adjudication software.
• Investigate missing elements in patient records and collaborate virtually with coders and auditors.
• Identify claims at risk for denial and proactively correct or escalate them.
• Keep pace with ever-evolving policies set by CMS, commercial insurers, and hospital networks.
• Maintain productivity benchmarks while achieving over 98% accuracy in data entry and review.
• Operate within encrypted cloud environments and follow best practices for secure documentation.

Work Environment

This is a fully remote position designed to strike a balance between flexibility and accountability. You’ll work independently yet stay closely aligned with your team through seamless digital communication. Regular check-ins, performance syncs, and collaborative case studies are part of your monthly routine. The remote culture is engineered for excellence, utilizing digital tools that eliminate bottlenecks and facilitate rapid feedback. Whether you’re stationed at home or working from a remote co-working hub, you'll have access to a digital infrastructure built for high performance.

Team Dynamics

We believe in transparent workflows, open dialogue, and results-focused evaluations. The team structure includes claims processors, clinical coders, quality auditors, and operational analysts—each role interconnected through cloud platforms. You’ll be encouraged to share process improvements and receive support through structured learning forums. Our organization celebrates curiosity, diversity of thought, and digital fluency.

Tools and Technology

Claims Platforms

• Epic Resolute for seamless patient financial workflows
• Cerner HealtheClaims for rules-based payer submission
• Meditech Expanse for integrated inpatient documentation

Analytical Dashboards

• Tableau to visualize productivity and audit trails
• Microsoft Power BI for daily metrics and team-level KPIs
• Google Looker for real-time claim trend forecasting

AI and Automation

• AI-assisted verification tools to pre-screen claims and reduce human error
• NLP models that highlight inconsistencies in medical narratives
• Robotic process automation (RPA) to flag duplicate or ineligible claims

Communication and Storage

• Slack for team channels and secure file transfer
• Zoom for one-on-one reviews and monthly retrospectives
• Microsoft Teams for collaborative policy updates
• AWS-based cloud storage for encrypted document sharing and retrieval

Qualifications

Required Experience

• 2+ years in inpatient claims processing or hospital billing
• Demonstrated knowledge of ICD-10, CPT, and DRG classification systems
• Experience with claim adjudication across both public and private payers
• Familiarity with HIPAA compliance and data security regulations

Preferred Skills

• Certification as CPC, CCS, or CRC by AAPC or AHIMA
• Exposure to remote claims systems such as TruBridge or Experian Health
• Understanding of inpatient audit methodologies and denial management trends

Behavioral Competencies

• An analytical mindset with high attention to numeric and textual accuracy
• Time management under strict submission deadlines
• Clear, professional communication in digital correspondence and documentation
• Self-motivated and accountable in an autonomous work setting

Measurable Success Indicators

Key Performance Metrics

• The claim accuracy rate sustained above 98% over each quarter
• Processing speed for standard claims is under 48 hours
• Error correction rate consistently minimized through proactive QA
• Audit readiness scored at 95% or higher by internal compliance teams
• Participation in two or more learning sessions per quarter to stay aligned with evolving payer criteria

Why Join Us?

This role allows you to operate at the intersection of healthcare operations and digital technology. Our team thrives on a shared mission to improve claim turnaround and patient billing clarity. We invest in AI-powered adjudication to relieve manual workload, while promoting human oversight for critical cases. You’ll not only be contributing to claim resolution, you’ll be shaping how inpatient data drives decision-making. Our workplace promotes upskilling, encourages innovation, and offers structured pathways to elevate your career beyond claims entry. From professional certifications to performance-based recognition, you’ll find your contributions meaningfully acknowledged. We believe in fostering sustainable careers with real opportunities for vertical and lateral movement within healthcare operations.

Career Path & Growth

Advancement Opportunities

Our growth-focused environment empowers claims processors to transition into roles such as:

• Remote Compliance Analyst overseeing internal claims audits
• DRG Validation Specialist specializing in severity coding logic
• Health Operations Coordinator driving team-wide performance analytics

Learning and Development

We provide:

• Sponsored certification programs in coding, analytics, or data compliance
• Access to premium learning platforms like Coursera and Udemy
• Internal mentorships with senior audit and quality teams
• Cross-functional projects with operational leaders to expand your scope

Call to Action

Are you ready to advance your career in a forward-thinking healthcare technology ecosystem? Apply today to become our next Remote Inpatient Claims Processor and help redefine how the industry handles complex inpatient billing workflows. Your talent can shape the way data translates into outcomes—join us and lead the evolution from behind the screen.