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Title
Text copied to clipboard!Healthcare Claims Processor
Description
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We are looking for a detail-oriented Healthcare Claims Processor to join our team. In this role, you will be responsible for reviewing, processing, and adjudicating healthcare insurance claims in accordance with company policies and regulatory requirements. You will work closely with healthcare providers, insurance companies, and patients to ensure that claims are processed accurately and in a timely manner. The ideal candidate will have a strong understanding of medical terminology, insurance policies, and claims processing procedures. You should possess excellent analytical skills, attention to detail, and the ability to work independently as well as part of a team. Your primary duties will include verifying patient and provider information, reviewing claim forms for completeness and accuracy, determining coverage eligibility, calculating benefit payments, and resolving discrepancies or issues that arise during the claims process. You will also be expected to maintain up-to-date knowledge of industry regulations, coding standards, and company guidelines. Strong communication skills are essential, as you will need to interact with various stakeholders to obtain necessary information and provide updates on claim statuses. The successful candidate will be comfortable working with claims management software and have the ability to handle a high volume of claims while maintaining accuracy and efficiency. If you are committed to delivering high-quality service and have a passion for 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 provider information for completeness and accuracy
- Determine coverage eligibility and calculate benefit payments
- Resolve discrepancies and issues related to claims processing
- Communicate with providers, patients, and insurance companies as needed
- Maintain up-to-date knowledge of industry regulations and company policies
- Document claim decisions and maintain accurate records
- Utilize claims management software and systems
- Meet productivity and quality standards
- Assist with audits and compliance reviews as required
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate’s or bachelor’s degree preferred
- Experience in healthcare claims processing or related field
- Strong knowledge of medical terminology and insurance policies
- Excellent attention to detail and analytical skills
- Proficient in claims management software and Microsoft Office Suite
- Strong communication and interpersonal skills
- Ability to handle confidential information with discretion
- Organizational and time management skills
- Ability to work independently and as part of a team
- Familiarity with HIPAA and other healthcare regulations
Potential interview questions
Text copied to clipboard!- Do you have experience processing healthcare insurance claims?
- Are you familiar with medical terminology and coding standards?
- How do you ensure accuracy when handling a high volume of claims?
- Describe your experience with claims management software.
- How do you handle discrepancies or disputes in claims processing?
- Are you comfortable working in a fast-paced environment?
- What steps do you take to stay updated on industry regulations?
- Can you provide an example of a challenging claim you resolved?
- How do you prioritize your workload?
- Are you familiar with HIPAA regulations?
