Claims Analyst I: Healthcare Billing & Claims Processing

MCS Puerto Rico; San Juan (PR); On-site; USD 40,000 - 55,000; Full time

Job summary

MCS Puerto Rico is seeking a claims processor to analyze and process professional and institutional claims. The role involves data entry, adjudication of payments, and issuing denials in line with policy requirements.

The position requires experience in data entry or medical billing within the healthcare insurance sector, plus a willingness to escalate complex cases to the next authorization level as needed.

Qualifications

• Bachelor's degree or higher is preferred with at least 6 months of data entry, medical billing, or provider call center experience.
• Prior data entry or billing experience in healthcare is favored.
• Proven ability to analyze and adjudicate claims within policy requirements.

Responsibilities

• Analyze and process simple to non-complex professional and institutional claims.
• Enter data, adjudicate payments, issue denials, and request additional information as needed.
• Process CMS-1500 and UB-04 claims according to required rules and timelines.
• Escalate claims beyond adjudication limits for higher authorization.
• Maintain productivity reports and accurate records in the inventory system.
• Comply with all company policies and applicable laws.

Skills

Data entry

Medical billing

Provider call center

Education

Bachelor's degree

Associate's degree

High school diploma or technical course

Job description

MCS Puerto Rico is seeking a claims processor to analyze and process professional and institutional claims. The role involves data entry, adjudication of payments, and issuing denials in line with policy requirements.

The position requires experience in data entry or medical billing within the healthcare insurance sector, plus a willingness to escalate complex cases to the next authorization level as needed.