Medical Billing Specialist

Job Title: Claims Specialist (Medical Claims)

Location: Boise, ID (Onsite)
Duration: Contract

Job Description

We are seeking a detail-oriented Claims Specialist to support medical claims processing operations. The ideal candidate will have experience reviewing and processing medical claims, a strong understanding of CMS-1500 and UB-04 claim forms, and the ability to communicate professionally with healthcare providers and claimants.

Key Responsibilities

• Scan, index, and accurately log medical bills and supporting documents into the claims management system (IRIS).
• Review CMS-1500 (Professional Claim Forms) and UB-04 (Institutional Claim Forms) for completeness and accuracy.
• Verify claim information, identify missing documentation, and contact medical providers to obtain required records.
• Interpret Explanation of Benefits (EOBs) and supporting medical documentation to assist with claims processing.
• Route completed claims to Claims Examiners for adjudication and payment.
• Maintain accurate electronic records while ensuring confidentiality of sensitive information.
• Respond professionally to inquiries from healthcare providers, claimants, and internal staff via phone and email.
• Follow established claims processing procedures and meet productivity and quality standards.

Required Qualifications

• Experience in medical claims processing, medical billing, or healthcare revenue cycle operations.
• Strong working knowledge of CMS-1500 (HCFA) and UB-04 medical claim forms.
• Ability to read and interpret Explanation of Benefits (EOBs), medical records, and insurance documentation.
• Familiarity with ICD-10, CPT, and HCPCS coding is a plus.
• Excellent attention to detail with strong data entry and organizational skills.
• Proficiency using claims management systems and Microsoft Office applications.
• Strong verbal and written communication skills with the ability to interact professionally with healthcare providers and clients.
• Ability to handle confidential information in compliance with privacy regulations.
• Ability to prioritize workload and work independently in a fast-paced environment.

Preferred Qualifications

• Prior experience in medical billing, claims adjudication, insurance operations, or healthcare administration.
• Experience working with provider billing, insurance reimbursement, or state healthcare programs.
• Familiarity with electronic medical records (EMR/EHR) and healthcare claims systems.

Note: All selected candidates must successfully pass the State of Idaho Background Check due to the confidential nature of the information handled in this role.