Medical Claims Specialist

2 days ago

nadiad, India beBeeClaims Full time

Job Title: Medical Claims SpecialistAs a detail-oriented and experienced medical claims specialist, you will play a crucial role in ensuring timely processing of healthcare claims. You will maintain high standards of accuracy and efficiency in claims processing while providing exceptional customer service to internal and external stakeholders.Key Responsibilities:Claim Review and Analysis: Review and analyze medical claims submitted by healthcare providers for accuracy, completeness, and compliance with insurance policies and regulatory requirements.Patient Eligibility and Insurance Verification: Verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.Coding and Adjudication: Assign appropriate medical codes (e.g., ICD-10, CPT) to diagnoses, procedures, and services according to industry standards and guidelines. Adjudicate claims based on established criteria, including medical necessity, coverage limitations, to ensure fair and accurate reimbursement.Claims Processing and Dispute Resolution: Process claims promptly and accurately using designated platforms. Investigate and resolve discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internal teams.Compliance and Professional Development: Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing. Participate in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall performance.Benefits:Opportunities for Growth: As a medical claims specialist, you will have opportunities to grow professionally and develop your skills in claims processing and management.Collaborative Team Environment: Work collaboratively with a team of experienced professionals who share a passion for delivering exceptional customer service and ensuring accurate and timely claims processing.

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