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AC
Anderson Cherokee Community Enrichment Services
Reimbursement Specialist
Career Insights for Medical Claims Processor / Representative
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Based on Texas 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.
$45,636 / year median in Texas
-1% projected decline
Job Description
Job Summary We are seeking a detail-oriented and proactive Reimbursement Specialist to join our ACCESS team. In this vital role, you will be responsible for managing the reimbursement process for medical claims, ensuring accurate billing, coding, and timely reimbursement from insurance providers. Your expertise will help optimize revenue cycle management while providing exceptional support to patients and mental healthcare providers. If you thrive in a fast-paced environment and have a passion for healthcare claims management, this is the perfect opportunity to contribute your skills and grow professionally. Duties Review and analyze medical claims to ensure accuracy and completeness before submission Utilize coding systems such as CPT (Current Procedural Terminology), ICD-9, ICD-10, and DRG (Diagnosis-Related Group) to assign appropriate codes for procedures and diagnoses Submit claims electronically through billing software and EMR (Electronic Medical Records) or EHR (Electronic Health Records) systems Follow up on unpaid or denied claims by communicating with insurance companies and medical offices to resolve discrepancies Maintain detailed records of claim submissions, adjustments, and reimbursements using Microsoft Office tools and healthcare claims management software Stay updated on health insurance policies, coding guidelines, and billing regulations to ensure compliance Provide excellent customer service by assisting patients and healthcare providers with billing inquiries and documentation requests Requirements Proven experience in medical billing, coding, or healthcare claims management with a strong understanding of medical terminology and records Familiarity with