OVERVIEW

We are seeking a Medical Claims Specialist to join our team. In this role, you will be responsible for managing and processing insurance claims, ensuring accuracy and compliance with industry standards. The ideal candidate will at least 2 years of medical claims & appeals experience on the provider side. You will play a crucial role in facilitating communication between healthcare providers, insurance companies, and patients to ensure timely resolution of claims.

QUALIFICATIONS

• Must have at least 2 years of medical claims & appeals experience on the provider side
• Experience with typing effective claims appeal letters.
• Familiarity with ICD-10, ICD-9, medical terminology, and coding systems is essential.
• Ability to work independently as well as part of a team in a fast-paced environment.
• Proficient in using medical office systems and software for claims processing.
• Excellent communication skills to effectively interact with healthcare providers and insurance representatives.
• Knowledge of medical collection processes is a plus.
  Join us as a Claims Specialist where your expertise will contribute significantly to our mission of providing exceptional service in the healthcare industry.
  Job Type: Full-time
  Pay: $17.50 - $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Vision insurance

Experience:

• Medical Appeals: 2 years (Required)

Work Location: In perso

• Review and interpret contractual terms for Managed Care, Commercial, Medicare, Medicaid and Workers’ Compensation when applicable.
• Review EOBs, HCPCS & ICD codes, HCFAs, and authorizations/referrals for identifying issues to obtain account resolution.
• Review and process insurance claims for accuracy and completeness.
• Utilize ICD-10, ICD-9, and other coding systems to ensure proper billing.
• Maintain up-to-date knowledge of medical terminology and coding practices.
• Collaborate with medical offices to resolve discrepancies in claims submissions.
• Communicate with insurance companies regarding claim status and follow up on outstanding claims.
• Manage medical records efficiently to support the claims process.
• Assist in the collection of outstanding payments from patients or insurance providers.
• Ensure compliance with all relevant regulations and guidelines in medical billing practices.