Medical Copay Claims Specialist
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Description
The Medical Copay Claims Specialist plays a critical role in ensuring the smooth and accurate processing of medical copay claims. This position involves meticulous attention to detail, proficiency in handling medical billing software, and being autonomous.
Requirements
Essential Functions and Responsibilities
The Medical Copay Claims Specialist plays a critical role in ensuring the smooth and accurate processing of medical copay claims. This position involves meticulous attention to detail, proficiency in handling medical billing software, and being autonomous.
Requirements
Essential Functions and Responsibilities
- Review and validate medical copay claims for completeness and accuracy.
- Ensure all required documentation is included and meets client and regulatory standards.
- Accurately input claim data into the billing system or electronic health records platform.
- Navigate and utilize various software applications to process claims efficiently.
- Apply knowledge of medical coding to ensure accurate benefit is provided.
- Investigate and resolve discrepancies or issues related to claims, including coding errors, eligibility concerns, rejections, and business rules disputes.
- Identify opportunities for process improvement and contribute to the development of best practices.
- Excellent written and oral skills.
- Computer literacy and keyboard typing skills.
- Proficiency in Microsoft Office Suites
- Ability to work independently and as part of a team in a fast-paced environment.
- Problem-solving skills and the ability to handle challenging situations with professionalism and empathy.
- Bilingual preferred – English/Spanish
- High school diploma or equivalent
- At least 18 years of age
- One year customer care experience
- This position does not have supervisory responsibilities/accountabilities.
- Work is performed within an indoor office environment utilizing standard office equipment.
- General office environment physical requirements include sitting, extensive use of computers and keyboards, lifting of less than 20 pounds plus walking and standing for long periods of time.
- Travel: This position does not normally require overnight travel.
- Remote Work: This position is not eligible for remote work.
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