Job Description
Job Description
As a medical claim processor, you will be responsible for reviewing and processing medical
claims timely and accurately according to our Program. The person is well organized and can
handle multiple priorities and meet deadlines as required.
The position reports directly to the Operations Manager.
Office Hours : Monday Thursday, 8 : 00am-5 : 00pm Friday, 8 : 30am-3 : 00pm
Essential Duties and Responsibilities :
- Reviews and processes medical claims based on policy provisions and established
- guidelines
- Requests additional information from members as needed
- Documents fully claims referred to senior staff for review and determination
- Maintains company production and quality standards
- Participates in training
- Checking patient insurance coverage and eligibility before billing.
- Handling patient inquiries about bills
- Navigating and maintaining electronic health records (EHR) and billing software, posting payments to patient accounts.
- Calling insurance companies for updates on claim status and to clarify billing details.
- Adhering to HIPAA regulations, ensuring patient confidentiality at all times.
- Staying updated on healthcare regulations, medical terminology, and coding practices.
- Tracking, reviewing, and reporting on billing metrics, trends, and periodic audits to ensure compliance and accuracy.
Other Responsibilities :
- Adheres to the company policies and procedures
- Maintains strict confidentiality of client, company and personnel information
- Demonstrates a strong commitment to the mission and values of the organization
- Adheres to company attendance standards
- Performs other duties as assigned
Skills Preferred :
- Medical terminology, diagnostic and CPT codes.
- Microsoft Office
- Efficient communication
- Proficiency with computers and medical billing software
- Knowledge of ethical debt collection practices and insurance guidelines
- Understanding of primary code classifications : ICD-10-CM, ICD-10-PCS, CPT and
- HCPCS
- Communication skills with patients / healthcare companies
- Basic accounting and bookkeeping practices
Education Experience
- Medical Billing and Coding Certification
- 1+ Years Experience in Medical Billing and Coding
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