Hybrid Medical Claims Eligibility Specialist II

Energy Jobline ZR; Houston (TX); Hybrid; USD 42,000 - 62,000; Full time

Job summary

MET Healthcare Solutions is seeking a Medical Claims Eligibility Specialist II to join our fast-paced organization. The role focuses on analyzing level II claims information to determine eligibility in the dispute resolution process in line with federal regulations and company policies.

The position offers a hybrid work arrangement after in-office training, with standard full-time hours Monday-Friday. The specialist will handle communications with providers and health plans and maintain

Qualifications

• Bachelor's degree required.
• 2 years healthcare claims analysis experience required.
• Billing and Coding Certification preferred or required.

Responsibilities

• Analyze EOBs and payment remittance documents to determine eligibility for dispute resolution.
• Compose correspondence in accordance with regulatory requirements and internal policies.
• Communicate with healthcare providers and health plans via email to obtain necessary information.
• Relay the status of claim submissions across multiple operating systems.
• Stay up to date on industry regulations to ensure proper strategy and compliance.
• Maintain electronic files for all claims determined eligible.

Skills

Medical claims analysis

EOB/Remittance knowledge

Insurance rules

Attention to detail

Multi-OS experience

Confidentiality & professionalism

Written & verbal communication

Education

Bachelor's degree

Job description

MET Healthcare Solutions is seeking a Medical Claims Eligibility Specialist II to join our fast-paced organization. The role focuses on analyzing level II claims information to determine eligibility in the dispute resolution process in line with federal regulations and company policies.

The position offers a hybrid work arrangement after in-office training, with standard full-time hours Monday-Friday. The specialist will handle communications with providers and health plans and maintain