Job Summary
The Claims Processor is responsible for accurately and efficiently processing healthcare claims submitted to third-party payors. This role ensures that claims are reviewed, submitted, and followed up on in accordance with regulatory requirements, payer policies, and organizational standards. The Claims Processor supports the revenue cycle process by identifying and resolving claim errors, submitting adjustments, and communicating with insurance payors to facilitate timely reimbursement.
Essential Functions
- Reviews claims for completeness, accuracy, and compliance with legal, regulatory, and payer-specific requirements.
- Submits claims to third-party payors through manual and electronic processes in accordance with established timelines.
- Tracks and documents all claim-related activity in the appropriate systems following standard workflow procedures.
- Prepares and processes account adjustment requests in accordance with departmental policies and guidelines.
- Composes and submits Service Support Requests (SSRs) or other internal forms to facilitate claim resolution.
- Contacts insurance payors to resolve claim rejections, denials, or discrepancies, ensuring timely follow-up and correction.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
Qualifications
- Associate Degree Accounting, Business or related area of study preferred
- 1-2 years of experience in medical claims processing or healthcare billing preferred
Knowledge, Skills and Abilities
- Knowledge of third-party billing procedures and healthcare claims processing.
- Familiarity with electronic claim submission systems and billing software.
- Strong attention to detail and accuracy.
- Effective verbal and written communication skills.
- Ability to prioritize tasks and manage time in a fast-paced environment.
- Proficiency in data entry and navigating billing or healthcare management systems.