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Title
Text copied to clipboard!Medical Claims Processor
Description
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We are looking for a detail-oriented Medical Claims Processor to join our team. The Medical Claims Processor is responsible for reviewing, evaluating, and processing medical insurance claims submitted by healthcare providers and patients. This role requires a strong understanding of medical terminology, insurance policies, and billing procedures. The ideal candidate will ensure that claims are processed accurately and efficiently, in compliance with company policies and regulatory requirements. The Medical Claims Processor will communicate with healthcare providers, insurance companies, and patients to resolve discrepancies, request additional information, and clarify claim details. Attention to detail, strong organizational skills, and the ability to work under tight deadlines are essential for success in this role. The position also involves maintaining accurate records, identifying fraudulent claims, and ensuring timely reimbursement for services rendered. The Medical Claims Processor will use specialized software to enter and track claims, generate reports, and monitor claim status. This role may also involve assisting with appeals, denials, and other claim-related issues. The successful candidate will demonstrate excellent communication skills, a commitment to customer service, and the ability to work both independently and as part of a team. Previous experience in medical billing, claims processing, or a related field is highly desirable.
Responsibilities
Text copied to clipboard!- Review and process medical insurance claims for accuracy and completeness
- Verify patient and provider information against submitted documentation
- Communicate with healthcare providers and insurance companies to resolve discrepancies
- Identify and flag potential fraudulent or incorrect claims
- Maintain accurate records of all processed claims
- Ensure compliance with company policies and regulatory guidelines
- Assist with claim denials, appeals, and resubmissions
- Use specialized software to enter and track claims
- Generate reports on claim status and processing metrics
- Meet productivity and accuracy targets set by management
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate degree preferred
- Previous experience in medical billing or claims processing
- Strong knowledge of medical terminology and insurance procedures
- Excellent attention to detail and organizational skills
- Proficient in using claims processing software and Microsoft Office
- Strong communication and customer service skills
- Ability to work independently and as part of a team
- Familiarity with HIPAA and other healthcare regulations
- Ability to handle confidential information with discretion
- Strong problem-solving and analytical skills
Potential interview questions
Text copied to clipboard!- What experience do you have with medical claims processing?
- Are you familiar with medical billing software?
- How do you ensure accuracy when reviewing claims?
- Describe a time you resolved a claim discrepancy.
- What steps do you take to identify fraudulent claims?
- How do you handle confidential patient information?
- Are you comfortable working under tight deadlines?
- What is your experience with insurance policies and procedures?
- How do you prioritize multiple tasks?
- Why are you interested in this position?
