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Title
Text copied to clipboard!Healthcare Claims Specialist
Description
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We are looking for a detail-oriented Healthcare Claims Specialist to join our team. In this role, you will be responsible for reviewing, processing, and managing healthcare insurance claims to ensure accuracy and compliance with industry standards. You will work closely with healthcare providers, insurance companies, and patients to resolve claim issues and facilitate timely reimbursements. The ideal candidate will have a strong understanding of medical billing, coding procedures, and insurance guidelines. Excellent communication and analytical skills are essential, as you will be required to investigate discrepancies, appeal denied claims, and provide support to both internal and external stakeholders. Your daily tasks will include verifying patient information, reviewing medical records, entering claim data into relevant systems, and ensuring that all claims are submitted within required timeframes. You will also be responsible for maintaining up-to-date knowledge of healthcare regulations and payer requirements. The Healthcare Claims Specialist plays a critical role in the financial health of healthcare organizations by ensuring that claims are processed efficiently and accurately. If you are organized, proactive, and passionate about making a difference in the healthcare industry, we encourage you to apply for this rewarding position.
Responsibilities
Text copied to clipboard!- Review and process healthcare insurance claims accurately and efficiently
- Verify patient and insurance information for completeness and accuracy
- Communicate with healthcare providers, insurance companies, and patients to resolve claim issues
- Investigate and appeal denied or underpaid claims
- Maintain up-to-date knowledge of insurance policies and healthcare regulations
- Enter and update claim information in relevant systems
- Ensure timely submission of claims to payers
- Identify and report claim discrepancies or potential fraud
- Assist with audits and compliance reviews
- Provide support and guidance to internal teams regarding claims processes
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate’s or bachelor’s degree preferred
- Experience in healthcare claims processing or medical billing
- Knowledge of medical terminology, coding (ICD-10, CPT), and insurance procedures
- Strong attention to detail and organizational skills
- Excellent communication and interpersonal abilities
- Proficiency with claims management software and Microsoft Office Suite
- Ability to handle confidential information with discretion
- Problem-solving skills and the ability to work independently
- Familiarity with healthcare regulations such as HIPAA
- Ability to manage multiple tasks and meet deadlines
Potential interview questions
Text copied to clipboard!- How many years of experience do you have in healthcare claims processing?
- Are you familiar with ICD-10 and CPT coding systems?
- Describe a time you resolved a denied claim. What steps did you take?
- How do you stay updated on changes in healthcare regulations?
- What claims management software have you used?
- How do you prioritize multiple claims with tight deadlines?
- Can you explain your process for verifying patient and insurance information?
- Have you ever identified and reported potential fraud? How did you handle it?
- What strategies do you use to communicate with difficult stakeholders?
- Are you comfortable working with confidential patient information?
