Job Overview
We are seeking a dedicated and detail-oriented Medical Insurance Specialist to join our healthcare administration team. The ideal candidate will possess a comprehensive understanding of medical billing, coding, and insurance claim processes, with a focus on accuracy and efficiency. As a Medical Insurance Specialist, you will be responsible for managing credentialing, managing insurance claims, verifying patient coverage, completing authorizations, and ensuring timely reimbursement while maintaining compliance with industry standards. Your expertise will contribute to streamlined operations and enhanced patient satisfaction.
Duties
- Review and process medical claims using coding systems such as CPT (Current Procedural Terminology), ICD-10 to ensure accurate billing and reimbursement.
- Verify patient insurance coverage and benefits, including DRG (Diagnosis-Related Group) classifications, to facilitate smooth claim submission.
- Collaborate with healthcare providers to ensure proper documentation and coding of medical procedures and diagnoses.
- Manage medical records and ensure all documentation complies with legal and regulatory requirements.
- Resolve claim denials or discrepancies through effective communication with insurance companies and patients.
- Utilize EMR (Electronic Medical Records) and EHR (Electronic Health Records) systems for data entry, claim submission, and record keeping.
- Conduct follow-up on outstanding payments or collections related to medical services rendered.
- Maintain up-to-date knowledge of industry regulations, coding updates, and insurance policies to optimize reimbursement processes.
Qualifications
- Proven experience in medical billing, coding, or insurance claims processing within a healthcare setting.
- Strong knowledge of medical terminology, medical records management, and billing procedures.
- Familiarity with DRG classifications, CPT coding, ICD-10 coding standards, and medical collection practices.
- Experience working with EMR/EHR systems for documentation and billing purposes.
- Excellent attention to detail with the ability to accurately interpret complex medical information.
- Effective communication skills for liaising with insurance providers, healthcare professionals, and patients.
- Prior experience in a medical office environment is preferred; relevant certifications in medical billing or coding are advantageous. Join our team to ensure efficient claims processing that supports quality patient care while maintaining compliance with industry standards!
Pay: $20.00 - $25.00 per hour
Experience:
- Medical billing: 1 year (Required)
Ability to Commute:
- Wexford, PA 15090 (Required)
Work Location: In person
