Medical Claims Eligibility Specialist

Job Description

Job Description

Medical Claims Eligibility Specialist

Houston Heights, TX 77018
$22.00/hour
Monday-Friday | 8:00 AM-5:00 PM
100% Onsite

  Contract-to-Hire Opportunity

Are you experienced in medical billing, claims processing, insurance follow-up, or healthcare collections? Join a growing healthcare organization where your attention to detail and analytical skills will play a key role in ensuring accurate claim reimbursement and eligibility determination.

What You'll Do

• Review Explanation of Benefits (EOBs) and payment remittances to determine claim eligibility.
• Investigate and follow up on unpaid, denied, or underpaid insurance claims.
• Process both in-network and out-of-network medical claims.
• Evaluate and resubmit claims in accordance with the No Surprises Act when applicable.
• Maintain accurate documentation and claim records.
• Analyze complex claims, including:
• • HCFA 1500
  • UB-04
  • Surgery and anesthesia claims
  • Coordination of Benefits (COB)
  • High-dollar reimbursement claims

What We're Looking For

• High School Diploma or GED required.
• Previous experience in medical billing, medical collections, claims processing, insurance reimbursement, or insurance follow-up.
• Ability to read and interpret EOBs and payment remittances.
• Strong organizational skills and attention to detail.
• Proficiency with Microsoft Office Suite, including Excel.
• Knowledge of the No Surprises Act is a plus.

Ideal Backgrounds

• Medical Biller
• Medical Collections Specialist
• Claims Specialist
• Insurance Follow-Up Representative