Claims Specialist

Job Description
We are looking for a Claims Specialist to join our team and help our business continue to grow.

Job Description:

The Claims Specialist is responsible for accurately processing medical insurance claims, ensuring compliance with industry regulations and guidelines, and resolving anyclaim-related issues. The Claims Specialist will be a detail-oriented individual who will be responsible for preparing claim forms,verifying information, and corresponding with agents andbeneficiaries. Will also handle client inquiries, review policies,determine coverage, calculate claim amounts, and process payments. Tobe successful as a claim processor, you should have excellentorganizational and interpersonal skills. This role requires a strongattention to detail, excellent organizational skills, and a solidunderstanding of medical billing procedures and insurance policies.

Primary Responsibilities:
•Claims Processing: Review and process medical insurance claimsaccurately and efficiently, ensuring all necessary information iscomplete and accurate.
•Coding and Documentation: Ensure proper coding of medicalprocedures and diagnoses using appropriate coding systems (e.g.,ICD-10, CPT) to facilitate accurate claims processing.
•Verification: Verify patient insurance information, includingeligibility, coverage, and benefits, before processing claims.
•Documentation Review: Review medical records and documentationto ensure that claims are supported by appropriate and valid documentation.
•Claim Status Follow-Up: Communicate with insurance companiesand healthcare providers to follow up on the status of claims, resolveclaim discrepancies, and provide necessary information for claim processing.
•Denials and Appeals: Investigate and resolve claim denials byidentifying discrepancies, addressing coding or billing errors, andpreparing appeals when necessary.
•Billing Accuracy: Review and reconcile billing statements toensure accuracy in charges and payments.
•Regulatory Compliance: Stay updated on relevant industryregulations, insurance policies, and coding guidelines to ensureclaims processing follows legal and regulatory requirements.
•Customer Service: Provide excellent customer service tohealthcare providers and insurance companies by addressing inquiriesand concerns related to claims processing.

Requirements

Skills & Qualifications:
•High school diploma or equivalent; healthcare administration,medical billing, or a related field (or equivalent experience) is a plus.
•Proficiency in medical billing software and electronic healthrecord (EHR) systems.
•Knowledge of medical coding systems (ICD-10, CPT, HCPCS) andinsurance claim submission processes.
•Strong attention to detail and accuracy in claims processing.
•Excellent communication and interpersonal skills for effectivecollaboration with team members, healthcare professionals, andinsurance representatives.
•Problem-solving skills to resolve claim discrepancies and denials.
•Knowledge of insurance regulations and compliance standards inthe healthcare industry.
•Ability to work independently and manage a high volume ofclaims efficiently.
•Familiarity with medical terminology and healthcare documentation.
•Computer literate and proficient in MS Office.
•Excellent critical thinking and decision-making skills.
•Strong customer service skills.

Experience:

Previous experience in medical billing, claims processing, or a related role is preferred.Familiarity with insurance policies and reimbursement procedures is an asset.

Benefits

Benefits:
•401(k)
•401(k) matching
•Dental insurance
•Health insurance
•Life insurance
•Paid time off
•Vision insurance