Medical Claims Processor
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
- High School diploma
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
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