Medical Coordinator - Claim Processing

Job Description:

The Medical Coordinator – Claim Processing is responsible for verifying and processing insurance claims, ensuring the accurate capture of medical information, and facilitating communication between insurance companies, healthcare professionals, and patients.

Key Responsibilities:

1. Claim Processing and Management:

• Review and process medical insurance claims for accuracy and completeness.
• Ensure compliance with insurance policies and healthcare regulations.
• Work with healthcare providers to gather necessary medical records and documentation to support claims.
• Verify the accuracy of patient and provider information before submitting claims.

2. Data Entry and Documentation:

• Enter claim details into the claim processing system.
• Maintain accurate records of all claims submitted, approved, and denied.
• Update patient accounts with relevant claim status and information.

3. Communication:

• Communicate with insurance companies to resolve claim issues, including denials and underpayments.
• Contact healthcare providers and patients for missing or incomplete information.
• Provide updates to patients and providers on claim status.

4. Review and Appeal:

• Review denied claims, identify reasons for rejection, and initiate appeals if necessary.
• Follow up on pending claims to ensure timely processing and resolution.
• Collaborate with medical coding and billing teams for accuracy in claim submissions.

5. Compliance:

• Ensure compliance with healthcare regulations (e.g., HIPAA) and insurance guidelines.
• Stay updated on changes in insurance policies, regulations, and claim processing procedures.
• Assist in audits to ensure all claims meet legal and policy standards.

6. Reporting:

• Generate reports on claim status, trends, and issues for management.
• Recommend improvements to claim processing efficiency and resolve recurring issues.

7. Skills and Qualifications:

• Education: A bachelor’s degree in healthcare administration, medical billing, or related fields is preferred.
• Experience (If any): Previous experience in medical billing, coding, or claim processing is highly preferred.
• Knowledge of Medical Terminology: Familiarity with medical terminology, billing codes, and insurance procedures.
• Attention to Detail: Ability to identify discrepancies and ensure accurate claim processing.
• Communication Skills: Strong verbal and written communication skills to interact with patients, healthcare providers, and insurance companies.
• Software Proficiency (For Experienced candidates): Familiarity with claim processing software (e.g., Epic, Cerner, or other medical billing software).

About the Role:

This position plays a vital role in ensuring the smooth processing of medical claims, affecting timely reimbursement for healthcare providers, and ensuring that patients’ financial and insurance needs are met accurately.

Note - Initially candidate will be hired as intern. Post completion of probation period confirmation regarding full time employment will be given.

Job Type: Full-time

Schedule:

• Day shift
• Night shift

Location:

• Pune, Maharashtra (Preferred)

Work Location: In person