Healthcare Claims Representative REMOTE

Role Summary: We are seeking a motivated and detail-oriented Healthcare Claims Representative to join our dynamic team. In this role, you will be the first point of contact for patients, families, insurance representatives, and internal staff, ensuring timely, accurate, and professional resolution of healthcare claims. You will play a critical role in maintaining exceptional customer service and compliance standards while supporting the claims submission process. This position offers the opportunity to contribute meaningfully to patient care by facilitating smooth billing and claims management. Key Duties and Responsibilities:

• Respond promptly and professionally to patient, family, and insurance inquiries regarding claims and billing.
• Review and verify patient insurance coverage and eligibility.
• Accurately process claims within established timeframes using claims processing systems.
• Match appropriate authorizations to claims and track any missing authorizations.
• Utilize knowledge of HCPC modifiers, coordination of benefits (COB), and billing guidelines for various services including anesthesia, hospital stays, and ambulance services.
• Communicate effectively with internal personnel, vendors, providers, and billing representatives regarding claim-related issues.
• Collaborate with the team to resolve claims issues and contribute to special projects.
• Report inconsistencies related to departmental policies and procedures to management.
• Provide administrative support including data entry, scanning, and filing as needed.
• Maintain confidentiality and comply with HIPAA and organizational requirements.
• Participate in department meetings, training sessions, and process improvement initiatives.
• Other duties as assigned.

Required Qualifications:

• High school diploma or GED required; Associate’s degree in Health Administration, Billing, or a related field preferred.
• 1–2 years of experience in medical billing, claims processing, or healthcare customer service, with familiarity in Medicare/Medicaid billing. Experience in long-term care or similar healthcare settings is highly desirable.
• Reliable transportation, a valid driver’s license, and required state auto insurance.
• Medically cleared for communicable diseases and up-to-date on all immunizations before engaging in direct patient contact.
• Successful completion of a comprehensive background check, which may include federal and state exclusion lists, criminal history, education and license verification, reference checks, and drug screening.

Desired Qualifications:

• Strong computer literacy, including Microsoft Office Suite (Outlook, Word, Excel, PowerPoint), email, and familiarity with electronic medical records (EMR) systems.
• Excellent written and verbal communication skills with the ability to correspond effectively and empathetically with patients and team members.
• Strong attention to detail and organizational skills with the ability to take ownership of responsibilities and deliver accurate, timely results.
• Ability to adapt to changing priorities with a proactive, solution-oriented mindset and a commitment to improving processes.
• Demonstrated empathy, professionalism, and a patient-first approach in all interactions.

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