What are the responsibilities and job description for the Medical Claims Processor position at The HIRD- USA?
We are seeking a detail-oriented and experienced Healthcare Claims Processor to join our team. The ideal candidate will have 1-2 years of experience in healthcare claims processing, with expertise in ICD-9 & ICD-10 coding, Medicare and Medicaid claims, and government operations. Strong computer skills and knowledge of Outlook, Word, and Excel are required. The candidate should also have excellent communication skills and the ability to explain insurance concepts such as copay, coinsurance, deductible, and out-of-pocket costs.
Key Responsibilities:
- Process and adjudicate Medicare and Medicaid claims accurately and efficiently.
- Review and analyze CMS-1500 & UB-04 forms for claim submissions.
- Perform claims rework and adjustments for M&R/Medicaid claims.
- Conduct data entry and paperwork processing related to medical claims.
- Ensure compliance with government regulations and healthcare policies.
- Explain Medicaid and Medicare eligibility requirements to stakeholders.
- Utilize ICD-9 & ICD-10 coding for accurate claim submissions.
- Collaborate with internal teams to resolve claim disputes and errors.
Required Qualifications:
- 1-2 years of experience in healthcare claims processing.
- Expertise in ICD-9 & ICD-10 coding.
- Experience in Medicare, Medicaid, and government healthcare programs.
- Knowledge of claims rework and adjustment processes.
- Strong understanding of copay, coinsurance, deductible, and out-of-pocket costs.
- Computer proficiency (Outlook, Word, Excel).
- Excellent verbal and written communication skills.
Preferred Qualifications:
- Experience with CMS-1500 & UB-04 forms.
- Prior back-office experience in medical claims processing.
- Hands-on experience in data entry and medical paperwork processing.
Salary : $19
