Medical Claims Specialist

Raleigh Orthopaedic Clinic; Raleigh (NC); Remote; USD 45,000 - 60,000; Full time

Job summary

A dynamic specialty medical practice is looking for a Medical Claims Specialist to manage insurance and billing needs. This full-time remote role requires a detail-oriented individual with experience in claims processing, and offers a supportive team environment along with comprehensive benefits.

Benefits

Comprehensive health, dental, and vision coverage

Retirement plan with employer contributions

Paid Time Off program

Supportive team environment

Qualifications

• Minimum 2 years of experience in medical claims processing or billing.
• Strong understanding of CPT, ICD-10, and HCPCS codes.
• Familiarity with EOBs and payer portals.

Responsibilities

• Review and submit medical claims to insurance carriers.
• Investigate and resolve claim denials and discrepancies.
• Follow up with insurance companies on unpaid claims.

Skills

Attention to detail

Organization

Communication

Tools

Athena

Epic

Kareo

Job description

Medical Claims Specialist – Full-Time Position – Remote – Must Reside in the Research Triangle Area, NC

We are a dynamic, fast-paced specialty medical practice committed to delivering exceptional care and service to our patients. We’re seeking an experienced, detail-oriented Medical Claims Specialist to join our team and help ensure accurate and timely processing of all insurance and billing needs.

Key Responsibilities:

- Review and submit medical claims to insurance carriers via electronic or paper billing systems.

- Verify insurance eligibility and benefits for patients.

- Investigate and resolve claim denials, rejections, and payment discrepancies.

- Coordinate with healthcare providers, coders, and billing staff to ensure proper documentation and coding.

- Follow up with insurance companies on unpaid or underpaid claims.

- Appeal denied claims in accordance with payer-specific guidelines.

- Maintain detailed records of billing activities and communications.

- Ensure compliance with HIPAA and payer-specific regulations.

- Assist patients with understanding their insurance coverage and balances if needed

Required Skills and Qualifications:

- Minimum 2 years of experience in medical claims processing or billing.

- Strong understanding of CPT, ICD-10, and HCPCS codes.

- Familiarity with EOBs (Explanation of Benefits), ERA/835 files, and payer portals.

- Proficiency in practice management software (e.g., Athena, Epic, Kareo).

- Excellent attention to detail, organization, and communication skills.

- Ability to work independently and meet deadlines.

What We Offer:

- Comprehensive health, dental, and vision coverage.

- Retirement plan with employer contributions.

- Paid Time Off program.

- Supportive team environment with room to grow.

- The chance to make a meaningful impact on patients’ access to care.