Benefits:
401(k)
401(k) matching
Bonus based on performance
Company parties
Competitive salary
Dental insurance
Health insurance
Opportunity for advancement
Paid time off
Parental leave
Training & development
Vision insurance
Medical Claims Specialist needed for full-time position offering $45-55K and benefits such as ability to work remotely (must live within commuting distance to Manchester, NH office to go on-site as needed), health insurance, paid time off, paid holidays, bonus, advancement and training opportunity and more! If you are looking for be part of a growing team that has a progressive and diverse culture; this might be the job for you!
Overview: We are seeking a detail-oriented and experienced Medical Claims Specialist to join our team. The ideal candidate will possess a strong understanding of medical billing procedures, insurance policies, and claim processing. As a Medical Claims Specialist, you will be responsible for accurately reviewing, processing, and resolving medical claims to ensure timely reimbursement for medical services rendered.
Responsibilities:
Claims Processing: Review and process medical claims in accordance with insurance guidelines and company policies. This includes verifying patient information, medical codes, and treatment details to ensure accuracy and completeness.
Claim Resolution: Investigate and resolve claim discrepancies, denials, and appeals promptly. Communicate with healthcare providers, insurance companies, and patients to gather necessary information and documentation for claim resolution.
Insurance Verification: Verify patient insurance coverage and eligibility prior to claim submission. Confirm benefits, deductibles, and co-pays to accurately calculate patient responsibility and ensure proper billing.
Coding Expertise: Ensure proper assignment of medical codes (ICD-10, CPT, HCPCS) to diagnoses and procedures for accurate billing and reimbursement. Stay updated on coding guidelines and regulations to maintain compliance with industry standards.
Documentation Management: Maintain organized records of claims, correspondence, and documentation related to claim processing. Ensure confidentiality and compliance with HIPAA regulations in handling sensitive patient information.
Adherence to Regulations: Stay informed about changes in healthcare regulations, insurance policies, and billing guidelines. Ensure compliance with federal and state regulations governing medical billing and claims processing.
Quality Assurance: Conduct audits and quality checks on processed claims to identify errors, discrepancies, or patterns of issues. Implement corrective actions and process improvements to enhance efficiency and accuracy.
Customer Service: Provide excellent customer service to patients, healthcare providers, and insurance representatives regarding claim inquiries, status updates, and resolution of billing issues. Address concerns and inquiries professionally and courteously.
Qualifications:
Bachelor's degree in healthcare administration, business administration, or related field preferred.
Proven experience as a Medical Claims Specialist or similar role in healthcare billing and reimbursement.
Strong knowledge of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance billing procedures.
Proficiency in using medical billing software and electronic health record (EHR) systems.
Excellent attention to detail and accuracy in data entry and documentation.
Effective communication skills, both verbal and written, with the ability to interact professionally with internal and external stakeholders.
Analytical thinking and problem-solving skills to resolve claim issues and discrepancies.
Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment.
Understanding of healthcare compliance regulations, including HIPAA, and commitment to maintaining confidentiality and ethical standards.
Flexible work from home options available.