Medical Claims Processor

Job Summary

A company is looking for a Medical Claims Processor.

Key Responsibilities:

• Review and compare data in the claim processing system with corresponding paper or electronic medical information
• Determine if services rendered were medically appropriate and met criteria by reviewing medical records when necessary
• Review claim edits and warning messages to make decisions on claim payment

Required Qualifications:

• Minimum of 1 year of claims processing experience
• High School degree or GED or equivalent experience
• Knowledge of physician practice and hospital coding, billing, and medical terminology
• Experience with UB/institutional and/or professional claims
• Knowledge of Medicare billing and payment guidelines and regulations