Medical Claims Processor

Globalchannelmanagement; Paramus (NJ); On-site; USD 45,000 - 65,000; Full time

Job summary

Globalchannelmanagement is seeking a Medical Claims Processor in Paramus, New Jersey. The ideal candidate will have over 3 years of experience processing medical claims and understanding insurance requirements.

Responsibilities include reviewing and transmitting claims, monitoring rejections, and partnering with clearing houses for billing. Strong problem-solving abilities are essential. This role offers a supportive environment to maximize claim collection rates.

Qualifications

• 3+ years related work experience is required.
• Proven ability to identify issues and solve problems.

Responsibilities

• Review medical claims and transmit to insurance carriers using EHR system.
• Monitor rejected claim reports and adjust claims for resubmission.
• Download EOPs to post claim payments and denials.
• Determine if denied claims can be corrected and re-submitted.
• Review aging reports to resubmit within filing limits.
• Utilize carrier websites to investigate denials and claim status.
• Partner with clearing house to distribute patient billing statements.
• Initiate overpayment refunds to patients and repayments to carriers.
• Support the corporate manager in maximizing claim collection rates.

Skills

Experience working in multiple doctor practices

Medical billing and coding

Understanding insurance claim requirements

Problem-solving skills

Job description

Medical Claims Processor needs 3+ years related work experience

Medical Claims Processor requires:

• Experience working in multiple doctor practices
• Medical billing. coding
• Experience working with multiple insurance carriers and an understanding of their claim requirements
• Proven ability to identify issues and solve problems

Medical Claims Processor duties:

• Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house.
• Monitor rejected claim reports and adjust claims for resubmission to the insurance carrier.
• Download insurance carrier explanation of payments (EOPs) to post claim payments and denials in the EHR system.
• Determine if denied claims can be corrected and re-submitted to the carrier.
• Review aging reports to research open balances and resubmit within insurance carrier filing limits.
• Utilize insurance carrier websites and contact carriers as needed to investigate denials and claim status.
• Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.
• Initiate overpayment refunds to patients and repayments to insurance carriers when required. Serve as the point of contact for the practice regarding all vision and medical claims.
• Support the corporate manager in maximizing claim collection rate