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Reducing costs and improving the experience for our clients and their clients.
Claims Processor
Location
Texas
Posted
70 days ago
Salary
0
Seniority
Senior
Job Description
Claims Processor
Health Admins
• Review and process medical claims submitted by members or providers promptly and accurately. • Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available. • Ensure compliance with insurance policies and industry standards. • Investigate and resolve any discrepancies or issues related to claim submissions. • Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. • Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. • Research complex medical billing and coding issues to support claims processing and audit activities. • Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication. • Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy. • Serve as members' primary point of contact regarding claims inquiries and resolution. • Respond promptly to customer inquiries and concerns with professionalism and empathy. • Collaborate with cross-functional teams to address customer issues and ensure timely resolution.
Job Requirements
- High School Diploma or equivalent
- Proven experience in medical claims processing and healthcare reimbursement
- Strong knowledge of medical terminology, medical coding, and insurance billing practices
- Technical Knowledge: SalesForce Experience, Google Suite Experience, Claims Management Software experience
- Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines
- Exceptional attention to detail and accuracy in data entry and documentation
- Effective verbal and written communication skills with a customer-centric approach
- Must be a self-motivator and self-starter
- Exceptional listening and analytical skills
- Solid time management skills
- Ability to multitask and successfully operate in a fast paced, team environment
- Must adapt well to change and successfully set and adjust priorities as needed
Benefits
- Competitive salary and benefits package
- Dynamic and innovative work environment
- Opportunities for professional growth and development
- Remote work
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