Responsibilities:
- Claim Processing: Accurately review and process medical claims according to established guidelines and procedures.
- Coding Verification: Ensure correct coding of diagnoses and procedures for claims submission.
- Claim Submission: Submit claims electronically or by paper to various health insurance companies within specified timelines.
- Follow-up on Claims: Monitor the status of submitted claims and follow up with insurance companies to resolve any issues or discrepancies.
- Payment Posting: Record and reconcile payments received from insurance companies with the billed amounts.
- Denial Management: Investigate and resolve claim denials by providing additional information or appealing the decision when necessary.
- Documentation: Maintain accurate and detailed records of all claim processing activities.
- Compliance: Adhere to healthcare regulations, insurance guidelines, and billing best practices to ensure compliance.
- Communication: Collaborate with internal teams, healthcare providers, and insurance representatives to resolve claim-related queries.
Qualifications:
- Bachelor's degree.
- Proven experience working in medical billing or claims processing role.
- Strong understanding of medical billing processes, including CPT and ICD coding.
- Proficiency in using billing software and electronic health record (EHR) systems.
- Excellent attention to detail and accuracy in data entry and claim processing.
- Knowledge of healthcare insurance plans, policies, and procedures.
- Ability to work independently and efficiently in a fast-paced environment.
- Effective communication skills to interact with internal and external stakeholders.
- Familiarity with HIPAA regulations and patient confidentiality requirements.
Job Type: Full-time
Application Question(s):
- Are you available for night shift?
Experience:
- Claim Processing: 2 years (Preferred)
Language:
- English (Preferred)
Work Location: In person
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