Healthcare Claims Professional
6 days ago
A Medical Claims Specialist works in healthcare facilities, responsible for submitting claims to insurance companies. They process data from medical coders, ensure claims get processed and paid, verify insurance coverage, review denied claims, and assist patients with billing questions.
Key responsibilities include managing inbound and outbound calls regarding inquiries, appointments, and data verification, helping with denials and follow-ups, correcting denial claims, and resubmitting claims, submitting electronic and paper claims, recording and verifying explanation of benefits, and providing administrative support.
Responsibilities- Manage incoming and outgoing calls related to patient inquiries, appointments, and data validation.
- Assist in resolving denials and follow-up on pending claims.
- Correct errors in denied claims and resubmit them.
- Submit claims electronically and via paper to primary, secondary, and tertiary insurance providers.
- Verify explanations of benefits and document accordingly.
- Familiarity with US Healthcare Claims Customer Service.
- Strong verbal and written communication skills.
- Previous experience in Insurance Billing Customer Service.
- HIPAA Certification is a plus.
- Excellent attention to detail.
- Impartial and highly organized.
- Proficient in computer systems.
- Positive work attitude and willingness to go the extra mile.
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