Medical Claims Examiner

7 days ago


Harlingen, Texas, United States Optimum Pain and Medical Spa Full time
Job Title: Medical Claims Examiner

About Optimum Pain and Medical Spa:
We are a leading medical spa committed to providing exceptional care to our patients. Our team is dedicated to delivering high-quality services in a safe and welcoming environment.

Job Summary:
We are seeking a detail-oriented Medical Claims Examiner to join our team. As a Medical Claims Examiner, you will be responsible for verifying the eligibility of insurances and submitting prior authorizations to ensure timely payment for medical procedures.

Main Responsibilities:
* Verify insurance eligibility and submit prior authorizations for medical procedures
* Understand and comply with Medicare/Medicaid rules and regulations
* Contact payer/referring physician offices as needed for referrals/authorizations
* Maintain accuracy and attention to detail when reviewing patient medical data and resolving discrepancies
* Audit appeals of denied claims and consult classification manuals to locate information about disease processes
* Ensure confidentiality and maintain the privacy of medical records

Requirements:
* High School Diploma or equivalent required
* 1 year of experience in a medical office setting preferred
* Strong communication and organizational skills
* Basic computer skills and proficiency in Microsoft Office applications

Estimated Salary: $45,000 - $55,000 per annum

About You:
We are looking for a motivated and detail-oriented individual who is passionate about delivering exceptional patient care. If you have a strong work ethic and excellent communication skills, we encourage you to apply.

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