Medical Claims Processor

Job OverviewWe are seeking a detail-oriented and experienced Medical Claims Processor to join our team.The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with industry regulations, contractual agreements, and best practices.The Medical Claims Processor will play a crucial role in ensuring timely processing of claims for healthcare services rendered, maintaining high standards of accuracy and efficiency in claims processing, and providing exceptional customer service to internal and external stakeholders.Key ResponsibilitiesReview and analyze medical claims submitted by healthcare providers for accuracy, completeness, and compliance with insurance policies and regulatory requirements.Verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.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 and coverage limitations, to ensure fair and accurate reimbursement.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.Collaborate with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication.Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and adherence to best practices in claims processing.Provide courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding claim status, inquiries, and appeals.Required Skills and QualificationsProven experience in medical claims processing or a related field.Strong analytical and problem-solving skills.Ability to work accurately and efficiently in a fast-paced environment.Excellent communication and customer service skills.Knowledge of ICD-10, CPT, and other medical coding systems.BenefitsOpportunity to work with a dynamic team.Professional development and growth opportunities.Competitive compensation and benefits package.Additional InformationMust be able to maintain confidentiality and handle sensitive information.Must be able to work independently and as part of a team.