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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. The ideal candidate will have a strong background in medical billing and coding, as well as a thorough understanding of insurance policies and procedures. This role involves reviewing and processing medical claims, ensuring accuracy and compliance with all relevant regulations. The Medical Claims Specialist will work closely with healthcare providers, insurance companies, and patients to resolve any issues related to claims. This position requires excellent communication skills, as well as the ability to work independently and manage multiple tasks simultaneously. The successful candidate will be responsible for maintaining accurate records, identifying discrepancies, and ensuring timely reimbursement for medical services. If you have a keen eye for detail and a passion for helping others navigate the complexities of medical insurance, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Review and process medical insurance claims.
- Ensure accuracy and compliance with relevant regulations.
- Communicate with healthcare providers, insurance companies, and patients.
- Resolve issues related to claims.
- Maintain accurate records of claims and reimbursements.
- Identify and correct discrepancies in claims.
- Ensure timely reimbursement for medical services.
- Assist in the preparation of reports and documentation.
- Stay updated on changes in insurance policies and procedures.
- Provide support and guidance to patients regarding their insurance coverage.
- Collaborate with other team members to improve claims processing efficiency.
- Handle appeals and denials of claims.
- Verify patient insurance coverage and benefits.
- Coordinate with billing departments to ensure accurate invoicing.
- Monitor claim status and follow up on outstanding claims.
- Assist in training new staff members on claims processing procedures.
- Participate in audits and quality assurance activities.
- Maintain confidentiality of patient information.
- Adhere to all company policies and procedures.
- Perform other duties as assigned.
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate's or bachelor's degree preferred.
- Certification in medical billing and coding (e.g., CPC, CCS) is a plus.
- Minimum of 2 years of experience in medical claims processing.
- Strong knowledge of medical terminology and coding systems (e.g., ICD-10, CPT).
- Familiarity with insurance policies and procedures.
- Excellent communication and interpersonal skills.
- Attention to detail and strong analytical skills.
- Ability to work independently and manage multiple tasks.
- Proficiency in using medical billing software and electronic health records (EHR) systems.
- Strong organizational and time management skills.
- Ability to handle sensitive and confidential information.
- Problem-solving skills and ability to resolve conflicts.
- Knowledge of relevant regulations and compliance standards.
- Customer service-oriented mindset.
- Ability to work in a fast-paced environment.
- Strong computer skills, including proficiency in Microsoft Office Suite.
- Ability to work well in a team setting.
- Flexibility to adapt to changing priorities and workloads.
- Commitment to continuous learning and professional development.
- Positive attitude and strong work ethic.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with medical billing and coding?
- How do you ensure accuracy and compliance when processing medical claims?
- What strategies do you use to resolve discrepancies in claims?
- How do you handle communication with patients regarding their insurance coverage?
- Can you provide an example of a time when you successfully resolved a complex claim issue?
- How do you stay updated on changes in insurance policies and procedures?
- What software and tools are you proficient in for medical claims processing?
- How do you prioritize and manage multiple tasks in a fast-paced environment?
- Can you describe a situation where you had to handle a denied claim and the steps you took to resolve it?
- How do you ensure confidentiality and security of patient information?
