Medical Billing Specialist

Medical Claims Analyst – Job Description A Medical Claims Analyst is responsible for reviewing, analyzing, and processing healthcare claims to ensure they are accurate, complete, and compliant with insurance policies, healthcare regulations, and company guidelines. Key Responsibilities: - Review and validate medical claims for accuracy and completeness - Analyze claim information, medical records, and supporting documentation - Verify patient eligibility, benefits, and insurance coverage - Interpret Explanation of Benefits (EOB) and insurance guidelines - Investigate and resolve claim denials, rejections, and payment discrepancies - Communicate with healthcare providers, insurance companies, and internal teams regarding claim issues - Ensure claims are processed within established turnaround times - Maintain accurate records and documentation of claim activities - Adhere to HIPAA regulations and company policies Qualifications: - High School Graduate, College Undergraduate, or College Graduate - Experience in US Healthcare, Medical Billing, Claims Processing, or Revenue Cycle Management is preferred - Knowledge of healthcare and insurance terminology, including copay, coinsurance, deductibles, and EOBs - Familiarity with CMS-1500 and UB-04 claim forms is an advantage - Strong analytical and problem-solving skills - Good communication and computer skills - Ability to work in a fast-paced environment and meet deadlines Primary Goal: To ensure medical claims are accurately reviewed and processed, helping healthcare providers receive appropriate reimbursement while maintaining compliance with insurance and healthcare regulations.