Medical Claims Processing Support Specialist

2 weeks ago


Phoenix, Arizona, United States IQVIA Full time
Position Overview:
As a Medical Claims Processing Support Specialist, you will play a crucial role in assisting patients and healthcare providers by managing medical claims efficiently. This position is designed for individuals who are detail-oriented and possess a strong understanding of medical billing processes.

Key Responsibilities:
1. **Claims Management:**
- Receive and review medical claims submitted by healthcare professionals or patients.
- Ensure that all necessary documentation is included and assess claims against specific program guidelines to determine eligibility for payment.

2. **Documentation and Verification:**
- Interpret Explanation of Benefits (EOB) and CMS1500 forms to verify claim details.
- Maintain accurate records of claims processed and decisions made.

3. **Customer Support:**
- Provide assistance to customers through various communication channels, addressing inquiries and resolving issues related to claims.
- Collaborate with team members to enhance service delivery and operational efficiency.

4. **Operational Improvement:**
- Identify challenges in the claims process and propose solutions to management for improved workflow.

Qualifications:
- High School Diploma or equivalent required.
- Proven experience in claims processing is essential.
- Medical Billing and Coding Certifications are mandatory.
- Familiarity with HIPAA regulations is necessary.
- Customer service experience is preferred, with bilingual skills (English/Spanish) being an advantage.

Work Environment:
This role is fully remote, allowing you to work from the comfort of your home while contributing to a global team dedicated to enhancing patient support services. The position requires a commitment of 40 hours per week, with flexible shift options available.

Compensation:
The hourly pay for this role is competitive, reflecting the skills and experience required for the position. IQVIA is committed to fostering a diverse and inclusive workplace, ensuring equal opportunities for all candidates.

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