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Title
Text copied to clipboard!Medical Claims Specialist
Description
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We are looking for a dedicated and detail-oriented Medical Claims Specialist to join our team. In this role, you will be responsible for managing and processing medical insurance claims, ensuring accuracy, and maintaining compliance with healthcare regulations. The ideal candidate will have a strong understanding of medical billing procedures, insurance policies, and claims processing systems. You will act as a liaison between healthcare providers, insurance companies, and patients to resolve claim issues and ensure timely reimbursements. Your ability to analyze data, communicate effectively, and maintain confidentiality will be critical to your success in this position.
As a Medical Claims Specialist, you will review and verify patient information, medical records, and insurance coverage to ensure claims are accurate and complete. You will also handle claim denials, appeals, and resubmissions, working closely with insurance companies to resolve discrepancies. This role requires a high level of organization, problem-solving skills, and a commitment to providing excellent customer service.
In addition to processing claims, you will stay updated on changes in healthcare regulations, insurance policies, and coding standards. You will also provide support to patients and healthcare providers by answering questions, explaining insurance benefits, and assisting with claim-related issues. Your expertise will contribute to the financial health of our organization and the satisfaction of our patients.
If you are passionate about healthcare administration and have a keen eye for detail, we encourage you to apply for this rewarding position. Join our team and make a difference in the lives of patients by ensuring they receive the insurance benefits they deserve.
Responsibilities
Text copied to clipboard!- Process and manage medical insurance claims accurately and efficiently.
- Review and verify patient information, medical records, and insurance coverage.
- Handle claim denials, appeals, and resubmissions with insurance companies.
- Communicate with healthcare providers, insurance companies, and patients to resolve claim issues.
- Ensure compliance with healthcare regulations and insurance policies.
- Maintain accurate records of claims and related documentation.
- Stay updated on changes in healthcare regulations, insurance policies, and coding standards.
- Provide support to patients and healthcare providers regarding claim-related inquiries.
Requirements
Text copied to clipboard!- Proven experience in medical billing, coding, or claims processing.
- Strong knowledge of healthcare regulations and insurance policies.
- Proficiency in medical billing software and claims processing systems.
- Excellent attention to detail and organizational skills.
- Strong communication and problem-solving abilities.
- Ability to handle confidential information with discretion.
- Familiarity with medical terminology and coding standards (e.g., ICD-10, CPT).
- High school diploma or equivalent; certification in medical billing or coding is a plus.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with medical billing and claims processing?
- How do you ensure accuracy and compliance when processing claims?
- Have you handled claim denials or appeals? If so, how did you resolve them?
- What medical billing software or systems are you proficient in?
- How do you stay updated on changes in healthcare regulations and insurance policies?
- Can you provide an example of a challenging claim issue you resolved?
- How do you prioritize tasks when managing multiple claims simultaneously?
- What steps do you take to maintain confidentiality and protect patient information?
