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Title
Text copied to clipboard!Medical Claims Specialist
Description
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We are looking for a detail-oriented and experienced Medical Claims Specialist to join our dynamic healthcare team. In this role, you will be responsible for the accurate and timely processing of medical insurance claims, ensuring compliance with policy provisions and state and federal regulations. Your expertise will play a crucial role in minimizing errors, enhancing patient satisfaction, and optimizing revenue flow for our organization. The ideal candidate will have a deep understanding of medical terminology, coding systems, and insurance policies, along with excellent analytical and communication skills. You will work closely with healthcare providers, insurance companies, and patients to resolve any discrepancies and ensure that claims are processed efficiently. This position requires a high level of precision and the ability to manage multiple tasks simultaneously in a fast-paced environment. Your contribution will directly impact our financial health and the quality of service we provide to our patients, making you a key player in our continued success.
Responsibilities
Text copied to clipboard!- Review and process medical insurance claims in accordance with company policies and procedures.
- Verify patient eligibility and claim accuracy, including coding and billing information.
- Liaise with healthcare providers and insurance companies to resolve any discrepancies or questions regarding claims.
- Maintain up-to-date knowledge of coding guidelines, insurance regulations, and compliance requirements.
- Ensure timely submission of claims to maximize revenue and minimize denials.
- Analyze denied claims and work on appeals with the necessary documentation and justification.
- Provide support and guidance to patients regarding their insurance claims and billing issues.
- Maintain accurate and organized records of all claims and correspondences.
- Collaborate with the finance department to reconcile billing discrepancies and ensure accurate financial reporting.
- Participate in audits and quality assurance processes to ensure the integrity of claims processing.
- Stay informed about industry trends and changes in insurance policies to advise and update the team accordingly.
- Educate healthcare providers and staff on best practices for billing and coding to reduce errors.
- Utilize specialized software for claims processing and maintain proficiency in its use.
- Report regularly to management on the status of claims processing and highlight any potential issues.
Requirements
Text copied to clipboard!- Bachelor's degree in Healthcare Administration, Finance, or related field.
- Minimum of 3 years of experience in medical billing or claims processing.
- In-depth knowledge of medical terminology, ICD-10, and CPT coding systems.
- Familiarity with health insurance policies, procedures, and regulations.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Proficiency in using medical billing software and Microsoft Office Suite.
- Ability to work under pressure and meet tight deadlines.
- Attention to detail and accuracy.
- Certification in medical billing or coding is preferred.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with medical billing and claims processing?
- How do you stay updated with changes in coding guidelines and insurance regulations?
- Describe a time when you resolved a particularly challenging insurance claim.
- How do you manage multiple tasks and prioritize your workload?
- What strategies do you use to minimize billing errors and claim denials?
- Can you explain the appeal process for a denied claim?
- How do you handle confidential patient information?
- What medical billing software are you most familiar with?