Hybrid Medical Claims Eligibility Specialist II

MET Healthcare Solutions; Texas; Hybrid; USD 52,000 - 78,000; Full time

Job summary

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

The position requires a Bachelor's degree and 2 years of healthcare claims analysis experience, with a preference for Billing and Coding Certification.

Qualifications

• Bachelor's degree is required.
• Healthcare Claims Analysis experience of 2 years is required.
• Billing and Coding Certification is preferred.

Responsibilities

• Analyze Explanation of Benefits (EOB) and 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 eligibility information.
• Relay the status of all claim submissions across multiple operating systems.
• Stay up to date on industry regulations and ensure appropriate strategies are in place.
• Maintain electronic files for all claims determined eligible.
• Review all types of medical claims, EOBs, and payment remittances (HCFA 1500, UB92, etc.).
• Understand insurance reimbursement rules and maintain confidentiality and professionalism.
• Demonstrate strong written and verbal communication skills and attention to detail.

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 analyzes level II claims information to determine eligibility in dispute resolution, in line with federal regulations and company policies.

The position requires a Bachelor's degree and 2 years of healthcare claims analysis experience, with a preference for Billing and Coding Certification.