Medical Claims Specialist

The Woman's Health Pavilion is a growing OB/GYN practice, established in 1971.
We are seeking a detail-oriented and knowledgeable Medical Claims Specialist to join our healthcare team. The ideal candidate will be responsible for managing and processing medical claims efficiently, ensuring accurate coding, billing, and reimbursement. This role is vital in maintaining the financial health of our healthcare operations and providing excellent service to our patients and providers. Prior experience with medical billing, coding, and electronic health record systems is highly valued. The position offers an opportunity to work in a professional environment dedicated to accuracy, compliance, and patient care excellence.

Duties

• Review and process medical claims using EMR and EHR systems to ensure timely submission and reimbursement
• Apply appropriate medical coding including ICD-10 and ICD coding standards for accurate claim generation
• Verify insurance coverage and patient eligibility prior to claim submission
• Resolve claim denials or rejections by analyzing errors related to medical records or coding inaccuracies
• Collaborate with healthcare providers to clarify documentation discrepancies
• Maintain detailed records of claims processed and follow up on outstanding payments or collections
• Ensure compliance with healthcare regulations and insurance policies during all claim handling activities
• Assist in updating and maintaining accurate medical records related to billing and claims processing

Skills

• Proficiency in medical billing, coding (ICD-10), and medical records management
• Strong understanding of medical terminology and healthcare documentation standards
• Experience working with EMR/EHR systems for claims processing and record management
• Knowledge of insurance policies, medical collections, and reimbursement procedures
• Ability to interpret complex medical data and accurately assign appropriate codes
• Excellent organizational skills with attention to detail to minimize errors in claims processing
• Effective communication skills for collaborating with healthcare providers, insurance companies, and patients
• Prior experience in a medical office setting is preferred but not required; training will be provided as needed

Qualifications

• High School Diploma/GED
• Experience a plus but not required
• Good verbal and written communication skills.
• Basic understanding of medical ICD 9/ 10 codes and CPT medical billing codes.
• Good telephone and patient relation skills.
• Detail oriented and ability to prioritize work.
• OB/GYN experience a plus

This position offers a rewarding opportunity for professionals passionate about healthcare administration, coding accuracy, and efficient claims management.

** This position is in-office only and does not offer remote work. **

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person