Medical Claims Eligibility Specialist - Billing & Collections

Medical Claims Eligibility Specialist - Billing & Collections

$22/Hour | Contract-to-Hire | Houston Heights (77018) | Monday-Friday, 8 AM-5 PM | 100% Onsite

A growing healthcare services organization is seeking a Medical Claims Specialist with experience in medical billing, insurance collections, high-dollar claims, or complex claims review. This is an excellent opportunity for candidates looking to expand their healthcare reimbursement and claims expertise, with the potential for career advancement and increased pay based on performance.

Responsibilities

• Review and analyze Explanation of Benefits (EOBs) and payment remittance documents to determine claim eligibility for dispute resolution.
• Perform insurance collections and follow up on outstanding claim payments.
• Process billing for in-network and out-of-network medical claims.
• Review and resubmit claims under the No Surprises Act when applicable.
• Maintain accurate electronic and physical claim files.
• Review a variety of medical claims, including:
• • HCFA 1500
  • UB-92/UB-04
  • Surgery and anesthesia claims
  • COB claims
  • DRG/RCC pricing
  • High-dollar and complex medical claims
• Apply knowledge of insurance reimbursement guidelines and payment methodologies.

Qualifications

• High School Diploma or GED required.
• Experience in medical billing, medical collections, claims processing, or insurance reimbursement.
• Experience reviewing EOBs and payment remittances.
• Strong attention to detail and accuracy.
• Ability to manage changing priorities in a fast-paced environment.
• Proficiency with Microsoft Office and intermediate Excel skills.
• No Surprises Act experience is a plus.

Ideal backgrounds: Medical Biller, Medical Collections Specialist, Claims Specialist, Insurance Follow-Up Representative, or Healthcare Reimbursement Specialist.

Important: Candidates should live within approximately 30 minutes of the Houston Heights area due to traffic and the fully onsite schedule.