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insurance claims specialist
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A&M Damage solutions LLc
Toms River, NJ (In Person)
$46,373 Salary, Full-Time
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Job Description
Job Summary We are seeking a dynamic and detail-oriented Insurance Claims Specialist to join our dedicated team. In this role, you will be responsible for managing and processing insurance claims related to medical services, ensuring accuracy and compliance with industry standards. Your expertise will help streamline the claims process, facilitate effective communication with healthcare providers and insurance companies, and contribute to the overall efficiency of our medical billing operations. If you thrive in a fast-paced environment, possess strong analytical skills, and are passionate about delivering exceptional service, this is an exciting opportunity to make a meaningful impact in healthcare administration. Duties Review and analyze insurance claims for completeness and accuracy, ensuring all necessary documentation is included. Utilize coding systems such as DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology), ICD-9, and ICD-10 to accurately code medical procedures and diagnoses. Verify medical records, billing information, and supporting documentation to facilitate claim approval or identify discrepancies. Communicate effectively with healthcare providers, insurance companies, and patients to resolve claim issues or request additional information. Prepare and submit claims through Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems using up-to-date coding standards. Follow up on pending claims, track payment statuses, and initiate appeals or corrections when necessary. Maintain detailed records of all claim activities, correspondence, and adjustments for audit purposes. Experience Proven experience in medical coding, billing, or claims processing within a healthcare setting. Strong knowledge of DRG classifications, CPT coding procedures, ICD-9/ICD-10 coding standards, and medical terminology. Familiarity with medical records management and medical collection processes. Hands-on experience working with EMR/EHR systems for claim submission and documentation review. Excellent understanding of insurance policies, reimbursement procedures, and medical billing regulations. Prior experience in a medical office environment is preferred but not required. Ability to interpret complex medical information accurately while maintaining attention to detail. Join us in transforming healthcare administration through precision coding and efficient claims management! Your expertise will ensure timely reimbursements while supporting our mission to provide outstanding patient care.