
Medical Claims Examiner Specialist
1 day ago
We are seeking a reliable and experienced medical claims examiner specialist to join our team. This role is vital to our operations, supporting sleep studies and DME services.
- Main Responsibilities:
- Verify patient insurance benefits and eligibility for sleep studies, DME, and related procedures.
- Obtain prior authorizations efficiently and accurately.
- Understand and explain co-pays, deductibles, and co-insurance to patients.
- Work with various insurance plans including HMO and PPO.
- Document and track authorizations in electronic medical record systems and Excel.
- Communicate clearly and professionally with patients and insurance companies.
- Support front office and billing teams when needed.
- Handle a high call volume with excellent phone etiquette and attention to detail.
Key Requirements:
- A minimum of 2 years of experience in medical claims examination and prior authorization.
- Strong knowledge of co-pays, deductibles, co-insurance, and insurance plan types.
- Familiarity with sleep studies and DME services is preferred but not required.
- The ability to multitask, stay organized, and adapt to changing priorities.
- Excellent verbal and written communication skills.
- Proficiency in electronic medical record systems and Microsoft Office, particularly Excel.
- A strong team player with a positive attitude and proactive approach.
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