Medical Health Claim Form

Job Description

We are seeking a dedicated and detail-oriented Medical Health Claim Form Analyst to join our team. This remote position is responsible for managing and processing medical claims, ensuring that data is accurately captured from various healthcare forms such as HCFA (CMS 1500), UB04, and Dental Claim Forms (ADA). The role will evolve to encompass broader responsibilities, including claims processing, prior authorizations, medical records management, and revenue cycle management across multiple phases. Key Responsibilities: Data Capturing from Healthcare Documents: Accurately capture data from HCFA (CMS 1500) forms for healthcare claims related to physician services. Process and verify data from UB04 (Uniform Billing) forms for institutional claims such as hospital or facility billing. Review and enter Dental Claims (ADA), ensuring correct data entry from dental service claims. Claims Processing Editing: Review claims submitted by healthcare providers for completeness, accuracy, and compliance with payer requirements. Edit and modify claims based on payer guidelines to ensure timely and accurate claim submissions. Prior Authorization: Coordinate with healthcare providers to obtain prior authorization for specific medical services and procedures, ensuring proper approval before services are rendered. Enrollment Processing: Manage the enrollment process for members, ensuring accurate information and seamless integration into the system. Payment Integrity: Conduct audits to verify the accuracy of claim payments, identifying discrepancies and implementing corrective actions. Revenue Cycle Management (RCM): Oversee the full revenue cycle process, from claim submission to payment, ensuring accuracy and completeness at every step. Revenue Integrity: Monitor claims to ensure compliance with healthcare regulations and payer policies, ensuring that all charges are accurately captured and billed. Denials Management: Investigate and resolve denied claims, identifying root causes and working to prevent future denials. Claim Submission Editing: Submit corrected claims and follow up with the payer to ensure timely processing. Medical Records Management: Ensure that medical records are complete, accurate, and compliant with regulatory requirements. Perform eligibility verification for patients to confirm coverage and benefits. Medical Records Coding: Assign appropriate codes (ICD-10, CPT, HCPCS) to medical diagnoses and procedures to ensure accurate billing and reimbursement. Patient Demographics Registration: Ensure patient demographic information is accurately recorded and updated in the system. Pre-certification: Verify and manage pre-certification requests to ensure medical procedures or services are authorized by insurance companies. Accounts Receivable: Manage and follow up on outstanding balances, ensuring timely collection of payment. Charge Entry / Charge Posting: Enter charges for services rendered into the system and ensure accurate posting. Medical Logs Indexing: Organize and index medical logs for easy access and retrieval when needed. Physician Hospital Billing: Handle billing processes related to physician services and hospital services. Appeals: Respond to and manage appeals for claims that have been denied or underpaid. Qualifications: Education: Bachelor s degree in Health Administration, Business, or related field (preferred). Certification in Medical Billing or Coding (e.g., CPC, CCS) is a plus. Experience: Minimum 1-2 years of experience in medical claims processing, healthcare billing, or revenue cycle management. Familiarity with HCFA (CMS 1500), UB04, and Dental Claim (ADA) forms is highly preferred. Experience in working with medical codes (ICD-10, CPT, HCPCS) is beneficial. Skills: Strong attention to detail and accuracy. Proficiency in healthcare software, billing systems, and databases. Knowledge of payer policies, coding systems, and regulations. Excellent communication skills and the ability to work independently. Strong analytical skills and problem-solving abilities. Ability to manage multiple tasks and meet deadlines. Benefits: Health insurance, paid time off, 401(k), and other company benefits Overview Experience 1-2 Qualification Bachelor s degree in Health Administration, Business, or related field (preferred),Certification in Medical Billing or Coding (e.g., CPC, CCS) is a plus