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RH
RemX Healthcare
Health Care Insurance Clerk
Career Insights for Medical Claims Processor / Representative
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Based on Tennessee 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.
$41,248 / year median in Tennessee
-6% projected decline
Job Description
Job Summary We are seeking a dedicated and detail-oriented Health Care Insurance Clerk to join our dynamic healthcare team. In this vital role, you will be responsible for managing medical billing, processing insurance claims, and ensuring accurate coding and documentation. Your expertise will help streamline the reimbursement process, improve patient records accuracy, and support efficient healthcare claims management. This position offers an exciting opportunity to contribute to a fast-paced environment where your skills in medical coding, insurance procedures, and customer service will make a meaningful impact on patient care and organizational success. Responsibilities Review and process healthcare insurance claims using billing software, EMR (Electronic Medical Records), and EHR (Electronic Health Records) systems to ensure timely reimbursement. Accurately apply medical coding including DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding standards to classify diagnoses and procedures. Verify patient information, insurance coverage details, and medical records to facilitate smooth claim submission. Collaborate with healthcare providers to clarify billing discrepancies or incomplete documentation. Maintain comprehensive medical records and ensure compliance with healthcare regulations and privacy standards. Manage medical collections by following up on unpaid or denied claims while maintaining excellent customer service with patients and insurance companies. Utilize Microsoft Office tools for reporting, data entry, and record keeping related to billing activities. Qualifications Proven experience in medical office settings with a strong understanding of healthcare claims management and medical billing processes. Knowledge of medical terminology, medical coding (DRG, CPT, ICD-9, ICD-10), and health insurance policies. Proficiency in billing software, EMR/EHR systems, and Microsoft Office applications. Familiarity with healthcare regulations related to medical records confidentiality and billing compliance. Excellent organizational skills with attention to detail in handling medical records and coding accuracy. Strong customer service skills to effectively communicate with patients, providers, and insurance representatives. Prior experience working with ICD coding standards and familiarity with medical collection procedures is highly desirable. Join our team as a Health Care Insurance Clerk to play a crucial role in ensuring accurate billing processes that support quality patient care! Your expertise will help optimize our claims management system while providing exceptional service in a fast-paced healthcare environment.