Medical Claims Processor & Billing Specialist

ConnectiveRx; Pittsburgh (Allegheny County); Vor Ort; USD 22.000 - 28.000; Vollzeit

Zusammenfassung

ConnectiveRx is seeking a Claims Specialist to process medical claims from patients and HCPs across a broad product suite. You will verify forms, enter data in adjudication systems, and ensure claims are paid or rejected according to rules.

Collaborate with a supervisor and team leads on complex cases and process improvements. Ideal candidates have 1+ year in healthcare or case management, with experience in pharmacy benefits or medical billing.

Qualifikationen

• High School or GED required.
• 1+ years in a health care or case management setting.
• Experience working in pharmacy benefits, health care insurance, and/or medical billing a must.
• Health care or pharmaceutical experience, particularly in a medical claims processing, billing provider, or insurance environment.
• Knowledge of EOB and EOP statements.

Aufgaben

• Verifies the accuracy and completeness of claim forms and attachments, such as EOBs, EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required.
• Claims are paid or rejected based upon system adjudication and/or application of business rules external to the systems. Consult with the Team Lead or Supervisor for complex claims or clarification of business rules.
• Obtains missing information by calling or writing customers using standard scripts or form letters. Based on volume, may also process claims and/or answer phones.
• Refers to requests for escalation as needed and engages other internal areas such as Program Management, IT, and other Contact Center teams to resolve issues.
• Provide input and feedback to the Supervisor, Quality Management, and Training (among others) to improve processes, procedures, and training.
• Other projects and tasks as assigned

Kenntnisse

Medical claims processing

Customer service

Bilingual English/Spanish

High-volume processing

Documentation

Ausbildung

High School or GED

Tools

SelectRx

Pro-Care

FSV

Jobbeschreibung

ConnectiveRx is seeking a Claims Specialist to process medical claims from patients and HCPs across a broad product suite. You will verify forms, enter data in adjudication systems, and ensure claims are paid or rejected according to rules.

Collaborate with a supervisor and team leads on complex cases and process improvements. Ideal candidates have 1+ year in healthcare or case management, with experience in pharmacy benefits or medical billing.