Text copied to clipboard!
Title
Text copied to clipboard!Medical Claims Specialist
Description
Text copied to clipboard!
We are looking for a dedicated and detail-oriented Medical Claims Specialist to join our healthcare team. The Medical Claims Specialist plays a crucial role in ensuring accurate and timely processing of medical insurance claims, maintaining compliance with healthcare regulations, and providing exceptional customer service to patients and healthcare providers. The ideal candidate will have a strong understanding of medical billing procedures, insurance policies, and healthcare terminology.
In this role, you will be responsible for reviewing and analyzing medical claims to ensure accuracy and completeness. You will verify patient information, diagnosis codes, and treatment details to ensure compliance with insurance guidelines and regulations. Additionally, you will communicate with healthcare providers, insurance companies, and patients to resolve claim discrepancies and answer inquiries related to claim status and coverage.
The Medical Claims Specialist will also be responsible for maintaining accurate records of claims processed, payments received, and outstanding balances. You will identify and investigate denied or rejected claims, determine the reasons for denial, and take appropriate actions to resubmit or appeal claims as necessary. Your attention to detail and analytical skills will be essential in identifying trends and patterns in claim denials, allowing you to recommend process improvements to reduce future denials and improve overall efficiency.
Furthermore, you will stay updated on changes in healthcare regulations, insurance policies, and billing procedures to ensure compliance and accuracy in claim processing. You will collaborate closely with other departments, including billing, coding, and patient services, to streamline processes and enhance the patient experience.
The successful candidate will possess excellent communication and interpersonal skills, as you will frequently interact with patients, healthcare providers, and insurance representatives. You must demonstrate empathy and professionalism when addressing patient concerns and resolving claim-related issues.
We offer a supportive and collaborative work environment, opportunities for professional growth, and competitive compensation and benefits packages. If you are passionate about healthcare, possess strong analytical and problem-solving skills, and thrive in a fast-paced environment, we encourage you to apply for this rewarding position as a Medical Claims Specialist.
Responsibilities
Text copied to clipboard!- Review and process medical insurance claims accurately and efficiently.
- Verify patient information, diagnosis codes, and treatment details for compliance.
- Communicate with healthcare providers, insurance companies, and patients to resolve claim discrepancies.
- Maintain accurate records of claims processed, payments received, and outstanding balances.
- Investigate denied or rejected claims and take appropriate actions to resubmit or appeal.
- Stay updated on healthcare regulations, insurance policies, and billing procedures.
- Collaborate with billing, coding, and patient services departments to streamline processes.
Requirements
Text copied to clipboard!- High school diploma or equivalent; associate's degree in healthcare administration preferred.
- Minimum of 2 years of experience in medical billing or claims processing.
- Strong knowledge of medical terminology, billing codes, and insurance policies.
- Excellent analytical and problem-solving skills.
- Proficiency in medical billing software and Microsoft Office applications.
- Exceptional communication and interpersonal skills.
- Ability to work independently and manage multiple tasks efficiently.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with medical claims processing?
- How do you handle denied or rejected claims?
- What steps do you take to ensure accuracy when processing claims?
- 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 successfully?
