Our Medical Claims Processor job description includes the responsibilities, duties, skills, education, qualifications, and experience.
About the Medical Claims Processor role
A Medical Claims Processor is responsible for reviewing, verifying, and processing medical claims to ensure that claims are accurate and paid in a timely manner. This role involves maintaining records, gathering and reviewing data, resolving discrepancies, and communicating with health care providers.
Role Purpose
The purpose of a Medical Claims Processor is to review and process medical claims submitted by healthcare providers to ensure accuracy and compliance with established policies and procedures. This involves verifying the accuracy and completeness of the information provided, entering the information into a computer system, and making any necessary corrections. The Medical Claims Processor is also responsible for verifying the insurance coverage of the patient and ensuring that the claim is paid according to the terms of the patient's policy. In addition, the Medical Claims Processor must be knowledgeable of the different types of insurance plans, the different types of services provided, and any restrictions on the services. The Medical Claims Processor is also responsible for maintaining accurate records and providing customer service to healthcare providers and patients.
Medical Claims Processor Summary
Medical Claims Processor Job Summary
A Medical Claims Processor is responsible for accurately entering data related to medical claims into a computer system and ensuring that all claims are properly processed. This role requires a high attention to detail, good organizational skills, and the ability to work with a variety of people. The Medical Claims Processor will review and process both paper and electronic claims, verify coverage and benefits, investigate and resolve discrepancies, and provide customer service to healthcare providers. The successful candidate must be able to multitask, handle a fast-paced work environment, and stay current with changes in the insurance industry.
Medical Claims Processor Duties
- Verify and process medical claims submitted to insurance companies
- Review patient information for accuracy and completeness
- Investigate and resolve discrepancies in claims data
- Identify and report fraudulent claims
- Apply knowledge of medical terminology, coding and billing procedures
- Communicate with healthcare providers to obtain additional information
Medical Claims Processor Skills
- Data Entry
- Attention to Detail
- Knowledge of Medical Terminology
Medical Claims Processor Requirements
- High school diploma or equivalent
- Knowledge of medical terminology and coding
- Ability to accurately enter data into computer system
- Good organizational and problem-solving skills
Personal Traits
- Detail-oriented
- Organized
- Able to work independently