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Title
Text copied to clipboard!Healthcare Claims Specialist
Description
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We are looking for a dedicated and detail-oriented Healthcare Claims Specialist to join our team. The ideal candidate will have a strong background in healthcare claims processing, with a keen eye for detail and a commitment to accuracy. This role involves reviewing and processing insurance claims, ensuring compliance with all relevant regulations and guidelines, and providing exceptional customer service to both patients and healthcare providers. The Healthcare Claims Specialist will be responsible for verifying patient information, coding diagnoses and procedures, and working with insurance companies to resolve any issues or discrepancies. The successful candidate will possess excellent communication skills, both written and verbal, and will be able to work effectively in a fast-paced environment. Additionally, the Healthcare Claims Specialist will be expected to stay up-to-date with changes in healthcare regulations and insurance policies, and to continuously seek ways to improve the efficiency and accuracy of the claims process. This is a critical role within our organization, as it directly impacts our ability to provide timely and accurate reimbursement for healthcare services. If you are a motivated and detail-oriented professional with a passion for healthcare and a commitment to excellence, we encourage you to apply for this exciting opportunity.
Responsibilities
Text copied to clipboard!- Review and process healthcare insurance claims.
- Verify patient information and insurance coverage.
- Code diagnoses and procedures accurately.
- Ensure compliance with healthcare regulations and guidelines.
- Communicate with insurance companies to resolve issues.
- Provide exceptional customer service to patients and providers.
- Maintain accurate and up-to-date records.
- Identify and correct errors in claims submissions.
- Stay informed about changes in healthcare regulations.
- Collaborate with other departments to improve claims processes.
- Assist in training new team members.
- Prepare reports on claims processing activities.
- Handle appeals and denials of claims.
- Ensure timely submission of claims.
- Monitor and follow up on unpaid claims.
- Analyze claims data to identify trends and issues.
- Work with billing and coding staff to ensure accuracy.
- Respond to inquiries from patients and providers.
- Maintain confidentiality of patient information.
- Participate in continuous improvement initiatives.
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate's or bachelor's degree preferred.
- Minimum of 2 years of experience in healthcare claims processing.
- Strong knowledge of medical terminology and coding (ICD-10, CPT).
- Familiarity with healthcare regulations and insurance policies.
- Excellent attention to detail and accuracy.
- Strong analytical and problem-solving skills.
- Proficient in Microsoft Office Suite (Word, Excel, Outlook).
- Experience with healthcare claims software.
- Excellent written and verbal communication skills.
- Ability to work independently and as part of a team.
- Strong organizational and time management skills.
- Ability to handle confidential information with discretion.
- Customer service-oriented with a positive attitude.
- Ability to work in a fast-paced environment.
- Strong interpersonal skills.
- Commitment to continuous learning and improvement.
- Ability to handle multiple tasks and prioritize effectively.
- Knowledge of HIPAA regulations.
- Experience with electronic health records (EHR) systems.
- Ability to adapt to changing regulations and procedures.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with healthcare claims processing?
- How do you ensure accuracy when coding diagnoses and procedures?
- What steps do you take to stay informed about changes in healthcare regulations?
- Can you provide an example of a time when you resolved a complex claims issue?
- How do you handle confidential patient information?
- What software and tools are you proficient in for claims processing?
- How do you prioritize your tasks in a fast-paced environment?
- Can you describe a time when you provided exceptional customer service?
- How do you handle appeals and denials of claims?
- What strategies do you use to improve the efficiency of the claims process?
