Medical Claims Processor

Company Overview: Our Managed Care Facility is a reputable healthcare services provider committed to delivering excellence in patient care. We are currently seeking a detail-oriented and experienced Medical Claims Processor to join our team. If you have a strong background in healthcare claims processing and enjoy working in a dynamic environment, we invite you to apply for this exciting opportunity.

Position: Medical Claims Processor

Location: Remote

Job Type: Full-Time

Responsibilities:

1. Claims Verification:

   • Review and verify medical claims for accuracy and completeness.
   • Ensure that all necessary documentation is attached to support the claims.

2. Data Entry:

   • Accurately input claim information into the designated database or claims processing system.
   • Update and maintain electronic records of claims.

3. Adjudication:

   • Evaluate claims against established policies and procedures.
   • Determine the eligibility of claims for payment and process accordingly.

4. Communication:

   • Communicate with healthcare providers and insurance companies to gather additional information when needed.
   • Address inquiries and resolve issues related to claims.

5. Coding:

   • Assign appropriate medical codes to claims for billing purposes.
   • Ensure compliance with coding standards and guidelines.

6. Quality Assurance:

   • Conduct quality checks on processed claims to minimize errors and discrepancies.
   • Collaborate with the quality assurance team to enhance process efficiency.

Qualifications:

• Previous experience as a Medical Claims Processor or in a similar role.
• Experience with Medicare/Medicaid
• Knowledge of medical coding, billing, and claims processing procedures.
• Proficiency in using claims processing software and databases.
• Detail-oriented with strong analytical and problem-solving skills.
• Excellent communication and interpersonal abilities.

Benefits:

• Competitive salary.
• Comprehensive health and wellness benefits.
• Opportunities for professional development and advancement.
• Collaborative and inclusive work environment.