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AL
Advocare LLC
Biller
Career Insights for Medical Claims Processor / Representative
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Scorecard
Based on New Jersey 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.
$49,093 / year median in New Jersey
-5% projected decline
Job Description
Description Core Responsibilities Create Claims:
Turn medical information into insurance claims using correct billing codes. Submit toInsurance:
Send claims to insurance companies electronically or by mail.Bill Patients:
Send invoices to patients for copays, deductibles, or leftover balances.Fix Denied Claims:
Investigate and appeal claims that insurance companies reject.Track Payments:
Post incoming payments and update patient account records. Daily Tasks Check patient insurance coverage before appointments. Talk with insurance agents to check on claim progress. Set up payment plans for patients. Keep all patient data private under HIPAA rules. Reporting for office/update monthly for outstanding bills/payments This is an in office position Mon-Friday 8a-430p, Saturday PRN 8a-12p. This is not a remote position. Requirements Education & Experience High school diploma or equivalent is the minimum requirement for entry-level roles. 1 to 2 years of experience in a medical office, clerical role, or customer service setting is highly valued. Billing/Coder certification or degree Professional Certifications While not always legally required, having a certification significantly increases your job prospects and earning potential.The most recognized credentials include:
Certified Professional Biller (CPB)- Offered by the AAPC. Certified Medical Reimbursement Specialist (CMRS)
- Offered by the AMBA. Certified Medical Billing Specialist (CMBS)
- Offered by the MAB.