Medical Claims Specialist

Job Overview:

We are seeking a highly organized and detail-oriented individual to join our team as a Medical Claims Follow-up Specialist. The successful candidate will be responsible for reviewing denied or rejected claims, conducting thorough research to identify the reason for denial, and working with insurance companies and patients to resolve issues and ensure timely reimbursement. The ideal candidate will have strong communication skills, a customer service mindset, and the ability to work independently in a fast-paced environment.

Responsibilities:

• Review and monitor status on submitted claims to ensure the claims have been successfully received by the payors
• Review denied or rejected claims to identify the reason for denial
• Conduct research and gather necessary information to support claim appeals
• Work with insurance companies to resolve claim issues and ensure timely reimbursement
• Contact healthcare providers to obtain necessary documentation or clarification regarding claims
• Update patient accounts and follow up with patients regarding outstanding balances or insurance coverage
• Stay current with healthcare regulations and guidelines related to medical claims
• Maintain accurate and up-to-date records of claims and related activities
• Provide excellent customer service to patients, healthcare providers, and insurance companies
• Perform additional assignments and special projects based on business need at the direction of the Manager

Qualifications:

• High school diploma or equivalent; associate or bachelor’s degree in healthcare administration, business, or related field preferred
• Minimum of 2 years of experience in medical claims processing or related field
• Knowledge of medical terminology, CPT/HCPCS codes, and ICD-10 coding
• Proficiency in Microsoft Office and experience using healthcare billing software
• Strong attention to detail and ability to multitask in a fast-paced environment
• Excellent written and verbal communication skills
• Ability to work independently and as part of a team
• Customer service mindset and ability to handle sensitive or confidential information
• Adaptability and a willingness to take on additional tasks and responsibilities as needed.
• Knowledge of international payment and invoicing processes is a plus.

This is a full-time position with a competitive salary and benefits packages. If you meet the requirements and are interested in this position, please submit your resume and cover letter for consideration.