
Medical Claims Specialist
21 hours ago
We are seeking a detail-oriented and analytical individual to join our team as a Medical Claims Specialist.
About the RoleThis is an exciting opportunity for someone who enjoys working with numbers, analyzing data, and problem-solving. As a Medical Claims Specialist, you will play a vital role in maximizing insurance reimbursement for healthcare practice owners by analyzing claim data and identifying areas for improvement.
Key responsibilities include investigating root causes of medical insurance claim denial, underpayment, or delay, and proposing effective resolutions. You will also communicate with insurance carriers to follow up on unpaid claims, delayed processing, and underpayment, and develop and implement plans to resolve medical insurance claim denial appeals.
Requirements- You must have at least 6 months experience in US-based AR follow-up and charge and payment posting.
- A college degree in Computer Engineering, Mathematics, or a related field is required.
- You should possess proven expertise in data analysis and classification, strong analytical skills, and attention to detail.
- Familiarity with the US medical insurance industry and insurance claims processing cycle is essential.
- You should have knowledge of ICD-10, CPT, and HCPC coding systems, understanding of CMS-1500 and UB-04 claim formats, and experience with Vericle Software is an advantage.
- Excellent communication, problem-solving, and self-motivation skills are required, along with the ability to work autonomously and effectively manage time.
- Experience working with chiropractic, physical therapy, and mental/behavioral health specialties is preferred.
- You must be comfortable working on Eastern Time Zone/US Shift.
- You need reliable internet access at home and a laptop/desktop with at least 8 GB RAM.
This role offers a unique opportunity to make a real difference in the lives of healthcare practice owners and patients. If you are motivated, organized, and enjoy working in a fast-paced environment, we encourage you to apply for this exciting position.
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