Medical Claims Specialist (Remote)

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Written by AI from the job title and company, not by Vaya Health, so some details may not match this job. The employer's own page has the real description.

Job Overview

The Medical Claims Specialist at Vaya Health will play a pivotal role in ensuring the accurate processing and management of insurance claims. This position necessitates a detail-oriented professional who will verify and submit claims, address discrepancies, and work collaboratively with healthcare providers and insurers to facilitate seamless operations. The specialist will also maintain comprehensive records, monitor claim status, and ensure compliance with relevant policies and regulations.

Job Responsibilities

• Review and process medical claims for accuracy and completeness.
• Verify patient eligibility and benefits coverage with insurance providers.
• Communicate with healthcare providers to resolve billing discrepancies.
• Maintain accurate and organized electronic records of all claims processed.
• Stay updated on changes in healthcare regulations and insurance policies.
• Monitor claims to track status and provide updates to stakeholders.
• Assist in identifying trends in claims denials to improve processes.

Qualifications

• Associate's degree in health administration, medical billing, or a related field is required; Bachelor’s degree preferred.
• Minimum of 2 years of experience in medical billing and claims processing.
• Proficient understanding of medical coding (ICD-10, CPT, HCPCS) and billing software.
• Strong analytical skills with a keen attention to detail.
• Excellent communication skills, both written and verbal.
• Experience with electronic health record (EHR) systems is preferred.

Technologies & Tools

The Medical Claims Specialist will utilize various technologies and tools, including electronic billing software, EHR systems, and data management platforms. Familiarity with coding software such as 3M or Optum360, as well as Microsoft Office Suite (Word, Excel, and Outlook), will be essential for managing claims and maintaining thorough documentation.

Ideal Candidates

The ideal candidate for the Medical Claims Specialist position at Vaya Health will possess a strong attention to detail and exceptional organizational abilities. They will demonstrate a capacity for critical thinking and problem-solving, coupled with effective communication skills that facilitate collaboration across different teams. A proactive approach to learning and staying abreast of industry changes will also be vital, as will a commitment to providing excellent service to both clients and colleagues.