Medical Claims Processor I
New
B
Broadway VenturesHealthcare Administration
Remote United States, 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 ExcelHIPAA
Requirements
- High school diploma or equivalent.
- Minimum of five years of experience in medical claims processing (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.
- Experience with claim denial resolution and the appeals process.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
- Strong attention to detail and accuracy.
- Ability to interpret and apply insurance program policies and government regulations.
- Excellent written and verbal communication skills.
- Ability to manage a high volume of claims efficiently.
- Ability to work independently and collaboratively.
Responsibilities
- Analyze and process complex medical claims in accordance with program policies and procedures.
- Adjudicate claims according to program guidelines using critical thinking.
- Ensure timely processing and resolve barriers to meet client standards.
- Collaborate with internal departments to resolve discrepancies.
- Maintain patient record confidentiality per HIPAA regulations.
- Keep thorough records of processed and denied claims.
- Monitor trends and assist leadership with reporting.
- Engage in audits and compliance reviews.
- Mentor and train new claims processors.
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