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Title
Text copied to clipboard!Medical Claims Specialist
Description
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We are looking for a detail-oriented Medical Claims Specialist to join our healthcare administration team. In this role, you will be responsible for reviewing, processing, and resolving medical insurance claims to ensure timely and accurate reimbursement for healthcare services. You will work closely with healthcare providers, insurance companies, and patients to verify claim information, resolve discrepancies, and ensure compliance with industry regulations and company policies. The ideal candidate will have a strong understanding of medical billing procedures, insurance guidelines, and healthcare terminology. You should be comfortable working in a fast-paced environment, possess excellent analytical and communication skills, and be able to handle sensitive patient information with the utmost confidentiality. As a Medical Claims Specialist, your primary duties will include reviewing submitted claims for completeness and accuracy, verifying patient eligibility and coverage, coding and entering claim information into the system, and following up on denied or unpaid claims. You will also be responsible for communicating with insurance companies to resolve claim issues, appealing denied claims when necessary, and providing support to patients regarding their insurance benefits and claim status. Attention to detail, organizational skills, and the ability to work independently are essential for success in this position. Previous experience in medical billing, claims processing, or a related healthcare administrative role is highly preferred. Familiarity with electronic health records (EHR) systems, medical coding (ICD-10, CPT), and insurance regulations such as HIPAA is a plus. If you are committed to delivering high-quality administrative support in a healthcare setting and enjoy problem-solving, we encourage you to apply for this rewarding opportunity.
Responsibilities
Text copied to clipboard!- Review and process medical insurance claims for accuracy and completeness
- Verify patient eligibility, coverage, and authorization requirements
- Enter and update claim information in electronic health records systems
- Communicate with insurance companies to resolve claim issues and discrepancies
- Appeal denied or underpaid claims as necessary
- Ensure compliance with industry regulations and company policies
- Provide support to patients regarding insurance benefits and claim status
- Collaborate with healthcare providers and billing staff to resolve billing issues
- Maintain accurate records of claims and correspondence
- Monitor claim status and follow up on outstanding or unpaid claims
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate's or bachelor's degree preferred
- 1-3 years of experience in medical billing or claims processing
- Knowledge of medical terminology, coding (ICD-10, CPT), and insurance guidelines
- Familiarity with electronic health records (EHR) systems
- Strong attention to detail and organizational skills
- Excellent written and verbal communication skills
- Ability to handle sensitive and confidential information
- Problem-solving and analytical abilities
- Proficiency in Microsoft Office and billing software
- Ability to work independently and as part of a team
Potential interview questions
Text copied to clipboard!- How many years of experience do you have in medical claims processing?
- Are you familiar with ICD-10 and CPT coding systems?
- Describe your experience working with electronic health records systems.
- How do you handle denied or disputed insurance claims?
- What steps do you take to ensure accuracy in claim submissions?
- Can you provide an example of resolving a complex billing issue?
- How do you stay updated on changes in insurance regulations?
- What is your approach to maintaining patient confidentiality?
- Describe your experience communicating with insurance companies.
- Are you comfortable working in a fast-paced environment?
