Claims Specialist

Job Title:

Claims Specialist – Medical Billing

Job Summary:

We are seeking a detail-oriented and experienced Claims Specialist to manage medical billing and claims processing activities. The ideal candidate will be responsible for submitting, tracking, and resolving insurance claims while ensuring compliance with payer guidelines and healthcare regulations.

• Prepare and submit accurate medical claims (electronic and paper) to insurance carriers, Medicare, and Medicaid.
• Review patient accounts for billing accuracy, coding compliance (CPT, ICD-10, HCPCS), and proper documentation.
• Monitor claim status and follow up on unpaid, denied, or rejected claims.
• Analyze Explanation of Benefits (EOBs) and resolve payment discrepancies.
• Work on claim appeals, resubmissions, and adjustments to maximize reimbursement.
• Verify insurance eligibility and benefits prior to claim submission.
• Maintain compliance with HIPAA and healthcare billing regulations.
• Coordinate with providers, coders, and insurance representatives to resolve claim issues.
• Generate aging reports and maintain accurate records in billing systems.

• 1–3+ years of experience in medical billing or claims processing.
• Strong knowledge of CPT, ICD-10, and HCPCS coding.
• Experience with clearinghouses and EMR/EHR systems.
• Familiarity with Medicare, Medicaid, and commercial insurance policies.
• Proficiency in MS Excel and billing software.
• Strong analytical, communication, and problem-solving skills.

• Experience handling high-volume claims.
• Knowledge of denial management and revenue cycle management (RCM).
• Ability to work independently and meet productivity targets.