Medical Claims Specialist

1 day ago


Cambridge, Massachusetts, United States Prestige Utilization Management & Billing Solutions, LLC Full time
Medical Claims Specialist

Estimated Salary: $65,000 - $85,000 per year

Prestige Utilization Management & Billing Solutions, LLC is seeking an experienced Medical Claims Specialist to join our team. As a key member of our healthcare billing team, you will be responsible for reviewing and processing medical claims, ensuring accurate billing practices, and maintaining excellent communication with patients and insurance companies.

The ideal candidate will have a minimum of 1-year experience in healthcare billing, specifically in behavioral health treatment, with knowledge of Medi-Cal and EMR software programs. Strong understanding of insurance terminology, coding/billing certifications, and team collaboration skills are also essential.

Key Responsibilities:

  • Review patient census and KIPU/EMR records to confirm accurate charges.
  • Create and submit claims to payors.
  • Ensure accurate claim processing and payment through data review of insurance policies.
  • Maintain confidentiality of patient care and business information.
  • Demonstrate strong communication and interpersonal skills.
  • Maintain accurate records and perform other duties as assigned by the supervisor.


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