Medical Billing & Claims Specialist

Medical Claims Analyst

Job Type: Full-time
Department: Claims / Revenue Cycle Management
Reports To: Claims Manager or Revenue Cycle Manager

Position Summary

We are seeking a detail-oriented Medical Billing and Claims Specialist to review, analyze, and process medical claims to ensure accurate and timely reimbursement. This position is responsible for identifying claim discrepancies, researching denials and payment issues, verifying coding and billing information, and working with internal teams and insurance payers to resolve outstanding claims.

The ideal candidate has strong analytical and organizational skills, understands medical billing and insurance processes, and is comfortable working with large volumes of detailed information while maintaining accuracy and confidentiality.

Key Responsibilities

• Review medical claims for accuracy, completeness, and compliance with payer requirements.
• Analyze claim denials, rejections, underpayments, and payment discrepancies.
• Research and resolve outstanding claims using payer portals, billing systems, and other resources.
• Verify patient, insurance, provider, procedure, diagnosis, and authorization information as needed.
• Review medical billing and coding information, including CPT, HCPCS, ICD-10, and modifier usage.
• Identify trends and recurring issues that contribute to claim denials or delayed reimbursement.
• Prepare and submit corrected claims, reconsiderations, and appeals when appropriate.
• Communicate with insurance companies and internal departments to resolve claim issues.
• Maintain accurate documentation of claim research, correspondence, and resolution activities.
• Monitor assigned accounts and follow up on claims within established timelines.
• Assist with identifying opportunities to improve claims processing, reimbursement, and revenue-cycle performance.
• Maintain compliance with applicable healthcare regulations, payer requirements, and organizational policies.
• Protect confidential patient and financial information in accordance with HIPAA and company policies.
• Prepare reports and provide claim-related information to management as requested.

Qualifications

• High school diploma or equivalent required; associate degree or relevant healthcare/business education preferred.
• 1–3 years of experience in medical claims, medical billing, healthcare reimbursement, accounts receivable, or a related field.
• Working knowledge of health insurance plans, payer requirements, and claims processes.
• Familiarity with CPT, HCPCS, ICD-10, modifiers, and medical billing terminology.
• Strong analytical and problem-solving abilities.
• Excellent attention to detail and accuracy.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office, particularly Excel.
• Ability to manage multiple priorities and meet deadlines.
• Ability to handle confidential information professionally.

Preferred Qualifications

• Experience working with electronic medical records (EMR), practice-management, or claims-management systems.
• Experience with Medicare, Medicaid, commercial insurance, or managed-care claims.
• Experience researching and appealing denied or underpaid claims.
• Knowledge of healthcare revenue-cycle management.
• Medical billing or coding certification is a plus.

Key Skills

• Claims analysis
• Denial management
• Medical billing and reimbursement
• Insurance verification
• Payment reconciliation
• Claims research and appeals
• Data analysis
• Problem solving
• Attention to detail
• Communication and follow-up
• Confidentiality and HIPAA compliance

What We Offer

• Flexible work schedule
• Competitive salary
• Comprehensive benefits package
• Paid time off and holidays
• Professional development opportunities
• Supportive and collaborative work environment
• Opportunities for career growth

Equal Opportunity Employer: We are committed to providing equal employment opportunities to all qualified applicants and do not discriminate on the basis of legally protected characteristics.