Lead Assistant Manager

Claim Processing Specialist - Medical Records Retrieval

Job Summary:

The Claim Processing Specialist plays a crucial role in the efficient handling of medical claims and the retrieval of medical records. This position ensures timely processing and accuracy in claims, impacting both the organization’s revenue cycle and the quality of service we provide to our clients.

Key Responsibilities:

• Review and process medical claims in compliance with company policies and insurance regulations.
• Retrieve medical records from various healthcare facilities and maintain accurate records of all communications.
• Investigate and resolve discrepancies in claims by collaborating with healthcare providers and internal departments.
• Ensure timely submission of claims to insurance companies to enhance revenue cycle efficiency.
• Analyze claim data to identify trends, errors, and opportunities for process improvement.
• Prepare and submit appeals for denied claims, providing necessary documentation and follow-up.
• Maintain up-to-date knowledge of industry regulations and changes in claim processing protocols.

Requirements:

• High school diploma or equivalent; associate or bachelor’s degree in healthcare administration or a related field preferred.
• Proven experience in claim processing and medical records retrieval in a healthcare setting.
• Strong knowledge of medical terminology, coding (ICD-10, CPT), and insurance reimbursement processes.
• Excellent organizational skills with an attention to detail and accuracy.
• Effective communication skills, both verbal and written, to interact with healthcare professionals and clients.
• Proficient in using electronic medical record (EMR) systems and claim processing software.
• Ability to work independently and as part of a team in a fast-paced environment.

Preferred Qualifications:

• Certification in medical billing and coding (e.g., CPC, CCS) is highly desirable.
• Experience with specific health insurance plans and their claim requirements.
• Familiarity with healthcare regulations and compliance standards (e.g., HIPAA).
• Demonstrated ability to analyze complex data and provide actionable insights.

Benefits:

• Competitive salary with performance-based incentives.
• Comprehensive health, dental, and vision insurance plans.
• 401(k) plan with company matching contributions.
• Generous paid time off policy, including holidays and personal days.
• Opportunities for professional development and career advancement.
• Flexible work hours and remote work options available.
• Supportive and inclusive workplace culture that values diversity.