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.