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ProCare Rx

Medical Reimbursement Specialist

Career Insights for Medical Claims Processor / Representative

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Based on Florida data

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What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$41,153 / year median in Florida

-3% projected decline

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Job Description

Location:
Onsite, Miramar, FL Schedule:
Full-Time, Monday -
Friday Pay Rate:
$19.00/Hour
ESSENTIAL DUTIES AND RESPONSIBILITIES
: Submit medical claims to appropriate payer. Ensure resubmission of claims, when applicable, are accurate. Ensure reimbursement of claims by submitted the most appropriate coding for services performed. ICD diagnosis coding, modifier application and verification of CPT and/or HCPCS codes. Responsible for ensuring all claims processed through Emdeon (Change Healthcare) are correct and compliant. Responsible for performing payer enrollment follow up• Keeps abreast of and comply with coding guidelines and reimbursement reporting requirements. Daily review and follow up on all incomplete electronic provider-billing encounters. Identify issues, correct code and/or pend due to missing information. Keep up to date on medical insurance rules and proper filing guideline. Answer patient calls/questions, clinic staff calls, and insurance company calls. Maintain a professional relationship with insurance companies and patients. Other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS
Minimum 1 year of experience of medical
ICD & CPT
coding experience preferred. Electronic Medical Record experience, Emdeon (Change Healthcare) software highly preferred. Certified Pharmacy Tech a plus Proficient with Microsoft Office Suite. Excellent verbal and written communication skills. Excellent organizational and time management skills. Analytical, problem solving, and critical thinking skills. Ability to organize, coordinate, prioritize, and facilitate on-going tasks. Ability to work independently and with a team.
EDUCATION
High School Diploma or equivalent required. Medical Billing/Coder Certification from accredited entity a plus.
PHYSICAL DEMANDS
Requires sitting, standing, and occasional light lifting.
The Perks of Joining Our Team:
We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:
Comprehensive Health Benefits:
Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance. Time to
Recharge:
Paid vacation and holiday pay. Focus on
Your Wellness:
We offer a robust Employee Wellness Program. Invest in
Your Future:
401(k) with a company match.
Support System:
Employee Assistance Program provides confidential support and counseling. Get Rewarded for
Referring Great People:
Employee referral program. Ready to start your rewarding journey with us? Apply today! ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our recruitment team at HumanResources@procarerx.com. ProCare Rx is an Equal Opportunity Employer. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.