Medical Claims Coordinator

A leading healthcare organization is seeking a Medical Claims Coordinator to support accurate, timely, and compliant medical insurance claim submission. This role is ideal for someone with strong medical billing experience who thrives in a fast-paced revenue cycle environment and is committed to improving first-pass claim acceptance rates.

This position plays a critical role in claims submission, claims follow-up, payer communication, medical records management, and resolution of outstanding insurance claims.

Key Responsibilities

• Submit 100% of medical insurance claims through electronic and manual claim submission systems.
• Process claims for commercial insurance, Medicare, Medicaid, HMOs, PPOs, and other contracted payers.
• Complete claim status checks, follow-up processes, and payer verification workflows.
• Ensure all claims are clean, accurate, compliant, and properly coded before submission.
• Review Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) for denials and required corrections.
• Respond to medical records requests, payer audits, and documentation needs.
• Identify trends, root causes, and opportunities to improve first-pass acceptance and reduce claim denials.
• Communicate with insurance companies, patients, case managers, and healthcare providers.
• Maintain strict adherence to HIPAA, Medicare regulations, and state/federal billing requirements.
• Support team operations and assist with backup coverage as needed.
• Perform other revenue cycle or claims-related duties as assigned.

Required Skills & Competencies

• Strong knowledge of medical billing, claims processing, insurance verification, and payer guidelines.
• Experience with electronic billing platforms, practice management systems, and clearinghouses.
• Understanding of ICD-10, CPT, HCPCS coding, and claims compliance standards.
• Detail-oriented with excellent organizational and analytical abilities.
• Strong written and verbal communication skills.
• Ability to work independently and collaboratively in a healthcare operations environment.
• Proficiency with computers, spreadsheets, documentation systems, and billing software.

Qualifications

• Bachelor's degree preferred; equivalent experience accepted.
• Minimum 4+ years of experience in medical billing, claims submission, or healthcare revenue cycle.
• Medical billing certification (e.g., CMRS, CBCS, CPB) preferred but not required.