
Medical Claims Specialist
1 day ago
A skilled medical claims expert works in healthcare settings, ensuring accurate and timely submissions of insurance claims. Key responsibilities include reviewing data from medical coders, verifying insurance coverage, resolving denied claims, and providing billing support to patients.
Key Responsibilities:- Communication: Manage calls from patients, providers, and healthcare insurance companies regarding inquiries, appointments, and data verification
- Phone Etiquette: Maintain excellent phone etiquette at all times
- Denials and Follow-ups: Assist with denials and follow-ups, correcting denial claims and resubmitting as needed
- Claims Submission: Submit electronic and paper claims to primary, secondary, and third-party insurance companies
- Data Verification: Record and verify explanation of benefits for accurate claim processing
- Administrative Support: Provide administrative support, including data entry, verifying insurance, follow-ups, authorizations, and collections for outstanding balances and receivables
- Verbal and Written Communication: Excellent verbal and written English communication skills
- Customer Service Experience: Proven customer service experience in insurance billing
- Certifications: HIPAA Certification is a plus
- Time Management: Excellent time management and organizational skills
- Attention to Detail: Strong attention to detail and ability to work independently
- Impartiality: Impartial and unbiased in decision-making
- Computer Skills: Proficient in computer software and systems
- Hardware: Intel Core i5-5000 (5th Gen or higher) or AMD Ryzen 5 or higher processor, 8.00 GB RAM, Windows 10/11 64-bit or macOS Ventura operating system
- Peripherals: USB-type headset with noise-cancelling feature, camera capable of clear and crisp video output
- Internet Connection: Primary internet connection: DSL / Fiber Connection - Minimum of 8mb/s; Back-up internet connection: Minimum of 5mb/s
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