Job Title: Customer Support/ Claim Specialist
Department: Operations
Reports To: Fit
Job Summary:
The Claim Specialist manages the revenue cycle by processing medical claims, verifying insurance, and ensuring timely reimbursements. This role focuses on accurate billing, claims follow-ups, and minimizing denials to maximize revenue.
Key Responsibilities:
Process Medical Claims: Submit, track, and follow up on insurance claims to ensure prompt reimbursement.
Resolve Denials & Appeals: Investigate denied claims, submit appeals, and liaise with payers for resolution.
Verify Insurance & Eligibility: Confirm patient coverage, benefits, and pre-authorizations.
Ensure Compliance: Adhere to healthcare regulations, coding standards, and payer requirements.
Maintain Accurate Records: Update patient accounts, document claim statuses, and generate reports.
Required Qualifications:
Experience: 1-3 years in medical billing, claims processing, or revenue cycle management.
Knowledge: Familiarity with insurance guidelines, CPT/ICD-10 coding, and EHR/RCM software.
Skills: Strong attention to detail, problem-solving abilities, and proficiency in claims management.
Education: Associate’s degree or certification in medical billing, healthcare administration, or related field preferred.
Other: Understanding of HIPAA regulations and ability to work in a fast-paced environment.
Preferred Qualifications:
Proficiency in CPT, ICD-10, and HCPCS coding.
Experience with insurance claims processing, follow-ups, and appeals.
Knowledge of revenue cycle management (RCM), payer policies, and reimbursement processes.
Familiarity with HIPAA compliance and industry standards.
Experience with EHR/RCM software and medical billing systems.
Ability to analyze claim trends and generate reports to optimize revenue.
Key Competencies:
Attention to Detail: Ensures accuracy in claims and documentation.
Problem-Solving: Identifies issues and implements effective solutions.
Communication: Collaborates with payers, providers, and patients professionally.
Time Management: Prioritizes tasks efficiently to meet deadlines.
Adaptability: Quickly learns new systems and adjusts to evolving insurance policies.
Customer Service: Provides professional support to patients and internal teams.
Physical Requirements/Work Environment (if applicable)
A laptop or desktop computer running Windows 10 or later.
Reliable high-speed internet connection with at least:
*30 Mbps download speed
*5 Mbps upload speed (testable via speedtest.net).
Backup internet connection is required.
A dedicated work area free from distractions and background noise
Salary Range: Will be disclosed in the job offer.
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