Description

The Medical Copay Claims Processor plays a critical role in ensuring the smooth and accurate processing of medical copay claims. This position involves meticulous attention to detail, proficiency in handling medical billing software, and excellent communication skills to interact with internal teams, external stakeholders, doctor’s and provider’s offices and patients.

Requirements

Key Responsibilities

• Review and validate medical copay claims for completeness and accuracy. 
• Ensure all required documentation is included and meets client and regulatory standards.
• Accurately input claim data into the billing system or electronic health records platform.
• Navigate and utilize various software applications to process claims efficiently.
• Apply knowledge of medical coding to ensure accurate benefit is provided.
• Investigate and resolve discrepancies or issues related to claims, including coding errors, eligibility concerns, rejections, and business rules disputes.
• Consult with healthcare providers, pharmacies, HUB partners, and patients to obtain necessary information or resolve claim-related inquiries.
• Collaborate with internal operational and client facing to address claim-related issues.
• Identify opportunities for process improvement and contribute to the development of best practices.
• Receive inbound support calls and conduct routine outbound calls to providers offices and patients for various reasons.

Supervisory Responsibilities / Accountabilities

• This position does not have Supervisory Responsibilities/Accountabilities.

Required Skills/Abilities:

• Outstanding customer service skills. 
• Excellent written and oral skills. 
• Computer literacy and keyboard typing skills. 
• Proficiency in Microsoft Office Suites 
• Ability to work independently and as part of a team in a fast-paced environment. 
• Problem-solving skills and the ability to handle challenging situations with professionalism and empathy. 
• Bilingual preferred – English/Spanish.

Education and Experience:

• High school diploma or equivalent. 
• Must be 18 years of age. 
• Minimum of 1 year of customer service experience. 
• Experience in medical billing, and electronic health record systems preferred.

Working Conditions

Work is generally performed within an indoor office environment utilizing standard office equipment. 

General office environment requires frequent sitting; dexterity of hands and fingers to operate a computer keyboard and 

mouse; walking and standing for long periods of time; and lifting of less than 20 pounds.