Medical Claims Processor I
New
Remote, Monday through Friday, 8:30 AM to 5:00 PM ESTContractMiddle
Salary20 - 23 USD per hour
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Job Details
- Experience
- Minimum of five years of experience in medical claims processing
- Required Skills
- Microsoft Office SuiteHIPAA
Requirements
- High school diploma or equivalent.
- Minimum of five years of experience in medical claims processing, including professional, facility, complex, and high-dollar claims.
- Familiarity with ICD-10, CPT, and HCPCS coding systems.
- Understanding of medical terminology, healthcare services, and insurance procedures.
- Strong attention to detail and accuracy.
- Ability to interpret and apply insurance program policies and government regulations.
- Excellent written and verbal communication skills.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
- Experience with claim denial resolution and the appeals process.
- Ability to manage a high volume of claims efficiently.
- Strong problem-solving capabilities and a customer service-oriented mindset.
Responsibilities
- Analyze and process complex medical claims in accordance with program policies and procedures.
- Adjudicate claims by applying critical thinking to navigate complex scenarios.
- Ensure prompt claims processing to meet regulatory requirements.
- Collaborate with internal departments to resolve discrepancies and identify root causes.
- Maintain confidentiality of patient records per HIPAA regulations.
- Maintain accurate records of all claims processed, denied, or requiring investigation.
- Analyze and report claim trends to management.
- Engage in audits and compliance reviews.
- Mentor and train new claims processors as needed.
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