Medical Coordinator

3 days ago

Pune Maharashtra, India MKPIT Full time

Job Description:
The Medical Coordinator - Claim Processing is responsible for verifying and processing insurance claims, ensuring the accurate capture of medical information, and facilitating communication between insurance companies, healthcare professionals, and patients.

Key Responsibilities:
1. Claim Processing and Management:

- Review and process medical insurance claims for accuracy and completeness.
- Ensure compliance with insurance policies and healthcare regulations.
- Work with healthcare providers to gather necessary medical records and documentation to support claims.
- Verify the accuracy of patient and provider information before submitting claims.

2. Data Entry and Documentation:

- Enter claim details into the claim processing system.
- Maintain accurate records of all claims submitted, approved, and denied.
- Update patient accounts with relevant claim status and information.

3. Communication:

- Communicate with insurance companies to resolve claim issues, including denials and underpayments.
- Contact healthcare providers and patients for missing or incomplete information.
- Provide updates to patients and providers on claim status.

4. Review and Appeal:

- Review denied claims, identify reasons for rejection, and initiate appeals if necessary.
- Follow up on pending claims to ensure timely processing and resolution.
- Collaborate with medical coding and billing teams for accuracy in claim submissions.

5. Compliance:

- Ensure compliance with healthcare regulations (e.g., HIPAA) and insurance guidelines.
- Stay updated on changes in insurance policies, regulations, and claim processing procedures.
- Assist in audits to ensure all claims meet legal and policy standards.

6. Reporting:

- Generate reports on claim status, trends, and issues for management.
- Recommend improvements to claim processing efficiency and resolve recurring issues.

7. Skills and Qualifications:

- Education: A bachelor’s degree in healthcare administration, medical billing, or related fields is preferred.
- Experience (If any): Previous experience in medical billing, coding, or claim processing is highly preferred.
- Knowledge of Medical Terminology: Familiarity with medical terminology, billing codes, and insurance procedures.
- Attention to Detail: Ability to identify discrepancies and ensure accurate claim processing.
- Communication Skills: Strong verbal and written communication skills to interact with patients, healthcare providers, and insurance companies.

About the Role:
This position plays a vital role in ensuring the smooth processing of medical claims, affecting timely reimbursement for healthcare providers, and ensuring that patients’ financial and insurance needs are met accurately.

Schedule:

- Day shift
- Night shift

**Location**:

- Pune, Maharashtra (preferred)

Work Location: In person

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