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Medical Claims Associate

The Medical Claims Specialist is responsible for managing hospital and/or physician billing collections, ensuring accurate and timely processing of claims, and facilitating prompt payment from payers. This role will also work closely with various insurance providers, including Medicare, Medicaid, Blue Cross, and commercial health insurance carriers, to ensure accurate and timely reimbursement for medical services rendered.

Responsibilities

  • Examine medical claims to ensure accuracy and completeness.
  • Verify health insurance benefits and coverage for patients.
  • Follow up with payers regarding claim status and outstanding balances.
  • Identify and resolve issues preventing timely claim resolution.
  • Correct and resubmit claims as necessary to ensure prompt payment.
  • Maintain detailed documentation of all billing and collections activities.
  • Provide expert customer service to patients and insurance providers.
  • Ensure compliance with legal and regulatory requirements at all times.

Qualifications

  • In-depth understanding of insurance plans, including knowledge of different types of insurance coverage, member eligibility criteria, and medical billing processes.
  • Proficiency in medical billing codes and terminologies, including CPT, ICD-10, UB, HCFA, and 837 formats.
  • Strong interpersonal and customer service skills, with the ability to communicate effectively with patients, insurance providers, and internal stakeholders.
  • Meticulous attention to detail and problem-solving abilities, with a track record of accurately identifying and resolving billing issues.
  • Ability to gather, assess, and interpret relevant data and information to make informed decisions and address complex billing or claim-related inquiries.
  • Proficiency in mathematical calculations and numerical analysis, crucial for tasks such as calculating patient co-pays, deductibles, and insurance reimbursements accurately.
  • Strong aptitude for accurately recording and maintaining detailed documentation of billing and collections activities, including patient information, claim status updates, and resolution actions.
  • Demonstrated ability to meet and exceed productivity goals, with a focus on efficiency and accuracy in claim processing.
  • Candidates must understand medical billing processes and have experience in managing denied claims.
  • Candidates must be familiar with medical claim forms and must have the ability to interpret EOBs as necessary.

Screening Criteria

  • MUST HAVE STABLE EMPLOYMENT HISTORY.
  • Bachelor’s degree or equivalent combination of education and related work experience.
  • At least one (1) to five (5) years of experience in Revenue Cycle Management and medical billing claims.
  • Must have experiencing processing medical claims
Job Category: Healthcare
Job Location: Site Only

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