Medical Claims Specialist
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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.
Compensation : $45,000.00 - $55,000.00 per year
Our History
2006
The Bedford NH office opens and Staff Hunters begins working with more and more clients in the greater Manchester marketplace.
The personalized approach, consistency and high quality control creates a distinct competitive advantage in a market where fast growth at any cost is the norm.
2008
Ari joins the Bedford office of Staff Hunters to focus on building a Senior-level Finance practice in Southern, NH and Northern, MA.
2013
Sara opens the Administrative practice in Bedford and makes an immediate impact in the scope and depth of the recruiting and placement in the office.
2015
The Bedford office grows and Tony makes plans to transition toward retirement. Raven Ridge is founded and acquires the Bedford location.
The office expands and moves to a larger space in Bedford, NH. Payroll and billing operations move to the Bedford office.
Growth and change create new business partners and new relationships; both internal and external.
2016
A banner year for finding great team members! Dennis joins the Technical / Engineering group, assisting in the growth of the business.
Kassey joins the Administrative team offering expertise in the Administrative and Human Resources job market.
2020
Ashlee joins the organization to head up administrative operations in charge of payroll and billing.
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