Medical Claims Eligibility Specialist - Billing & Collections

Job Description

Job Description

Medical Claims Eligibility Specialist - Billing & Collections

$22/Hour | Contract-to-Hire | Houston Heights (77018) | Monday-Friday, 8 AM-5 PM | 100% Onsite

A growing healthcare services organization is seeking a Medical Claims Specialist with experience in medical billing, insurance collections, high-dollar claims, or complex claims review . This is an excellent opportunity for candidates looking to expand their healthcare reimbursement and claims expertise, with the potential for career advancement and increased pay based on performance .

Responsibilities

• Review and analyze Explanation of Benefits (EOBs) and payment remittance documents to determine claim eligibility for dispute resolution.
• Perform insurance collections and follow up on outstanding claim payments.
• Process billing for in-network and out-of-network medical claims .
• Review and resubmit claims under the No Surprises Act when applicable.
• Maintain accurate electronic and physical claim files.
• Review a variety of medical claims, including:
• • HCFA 1500
  • UB-92/UB-04
  • Surgery and anesthesia claims
  • COB claims
  • DRG/RCC pricing
  • High-dollar and complex medical claims
• Apply knowledge of insurance reimbursement guidelines and payment methodologies.

Qualifications

• High School Diploma or GED required.
• Experience in medical billing, medical collections, claims processing, or insurance reimbursement .
• Experience reviewing EOBs and payment remittances.
• Strong attention to detail and accuracy.
• Ability to manage changing priorities in a fast-paced environment.
• Proficiency with Microsoft Office and intermediate Excel skills.
• No Surprises Act experience is a plus.

Ideal backgrounds: Medical Biller, Medical Collections Specialist, Claims Specialist, Insurance Follow-Up Representative, or Healthcare Reimbursement Specialist.

Important: Candidates should live within approximately 30 minutes of the Houston Heights area due to traffic and the fully onsite schedule.