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.
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