Medical Claims Processor Job Description
A Medical Claims Processor is responsible for the accurate and timely processing of medical insurance claims submitted by healthcare providers and patients.
This role involves reviewing and verifying insurance claims, ensuring proper documentation and coding, and interacting with healthcare providers and insurance companies to resolve any discrepancies or issues.
Key Responsibilities:
- Review and Verify Claims: Analyze and validate medical claims to ensure they are complete, accurate, and compliant with insurance policies.
- Data Entry: Enter claim information into the organization’s database and update records as required.
- Claim Adjudication: Determine the eligibility of claims and the amount payable by the insurance company based on policy terms.
- Documentation and Coding: Ensure proper documentation and coding of diagnoses and procedures using ICD-10, CPT, and HCPCS codes.
- Communication: Liaise with healthcare providers, patients, and insurance companies to gather additional information or resolve claim discrepancies.
- Compliance: Stay informed about the latest regulations and guidelines in medical billing and insurance claims processing.
Medical Claims Processor Skills for Resume
When applying for a position as a Medical Claims Processor, it’s essential to highlight the specific skills and competencies that align with the job requirements. Here are some key skills to include on your resume:
- Attention to Detail: Ability to meticulously review claims for accuracy.
- Medical Coding Expertise: Proficiency in ICD-10, CPT, and HCPCS coding.
- Database Management: Skilled in data entry and maintaining accurate records.
- Analytical Abilities: Strong problem-solving skills for claims adjudication.
- Communication Skills: Effective communication with healthcare providers and insurance companies.
- Regulatory Knowledge: Understanding of healthcare regulations and insurance policies.
- Technical Proficiency: Experience with medical billing software and EHR systems.
- Efficiency: Competency in managing multiple claims and adhering to strict deadlines.
- Documentation: Strong ability to ensure proper documentation of claims and related processes.
- Customer Service: Providing knowledgeable support and resolving issues for claimants and providers.
By including these detailed descriptions and skills, you can create a comprehensive job posting or resume that clearly communicates your qualifications for the role of a Medical Claims Processor.