Clinical Claims Auditor
1 week ago
We are seeking a skilled Medical Billing Specialist to join our team at inAssist Healthcare Management Solutions.
This role involves reviewing complex healthcare claims, identifying discrepancies, and verifying pricing to reduce members' out-of-pocket healthcare costs.
The ideal candidate will have strong critical thinking and problem-solving skills, proficiency in EOB knowledge, and experience with medical billing and coding.
Key Responsibilities:
- Review patient medical bills, correspondence, and Explanation of Benefits (EOBs) for errors.
- Liaise with insurance carriers and providers to address identified issues.
- Communicate with providers and carriers via phone and email to ensure prompt and professional responses.
- Identify problems and inconsistencies using management reports and critical thinking skills.
- Utilize expertise and take initiative to resolve claims/billing issues.
- Apply appropriate processes and procedures for medical claims.
- Review and apply member benefit plans and provider contracts to ensure proper benefits and contract language is applied to each claim.
Requirements:
- Background in medical billing or insurance claims administration.
- 3-5+ years' experience in Medical Billing and Coding.
- Strong critical thinking and problem-solving skills.
- Proficiency in EOB knowledge.
- Strong interpersonal skills.
- Self-motivated and reliable.
- Proven exceptional ability to organize, prioritize, and communicate effectively with carriers and providers.
- Experience with Out of Network (OON) Benefits is advantageous.
- Understanding of general Coordination of Benefit Rules, Benefit Analysis.
- Knowledge of eligibility requirements and insurance enrollment.
- Experience in overturning claim denials.
Salary Estimate: $65,000 - $85,000 per year based on location and experience.
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