Virtual Medical Claims Coordinator

Vintti stands at the forefront of economically advantageous staffing solutions for US businesses. By facilitating partnerships between American companies and Latin American professionals, we offer a pathway to reduced operational costs without sacrificing quality. Our approach enables businesses to reinvest savings into core areas, fostering growth and enhancing overall market competitiveness.

A Virtual Medical Claims Coordinator is responsible for managing and processing medical insurance claims in a remote setting. This role involves assessing and verifying claims for accuracy and completeness, facilitating communication between healthcare providers, insurance companies, and patients, and ensuring timely reimbursements. They utilize specialized software to handle electronic claims submissions, track claim statuses, and resolve discrepancies. Strong organizational skills, attention to detail, and a comprehensive understanding of medical billing codes and insurance regulations are essential for success in this position.

- High school diploma or GED required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred
- 2+ years of experience in medical claims processing or healthcare billing
- Proficiency with medical billing codes (ICD-10, CPT, HCPCS)
- Strong understanding of healthcare insurance policies and regulations
- Familiarity with electronic health records (EHR) systems and claims processing software
- Exceptional attention to detail and accuracy in data entry
- Excellent communication skills, both verbal and written
- Strong problem-solving and analytical abilities
- Ability to manage multiple tasks and prioritize effectively
- Knowledge of regulatory compliance related to medical billing, including HIPAA
- Proficiency with Microsoft Office Suite, especially Excel and Word
- Ability to work independently and as part of a team
- Strong organizational skills and ability to maintain detailed records
- Familiarity with the appeals process for denied claims
- Experience with regular auditing of claims for compliance
- Ability to handle sensitive and confidential information
- Customer service skills to effectively respond to patient inquiries
- Eagerness to stay updated on industry changes and adapt to new processes
- Strong analytical skills for generating and interpreting claims reports

- Review incoming medical claims for accuracy and completeness
- Process medical claims using appropriate billing codes (ICD-10, CPT, HCPCS)
- Verify patient insurance coverage and eligibility
- Communicate with healthcare providers to obtain necessary documentation
- Input claim information into the claims processing system
- Adjudicate claims by approving, denying, or requesting additional information
- Resolve discrepancies in claim information
- Follow up on pending or incomplete claims
- Coordinate with insurance companies to clarify policy details
- Submit electronic and paper claims to insurance carriers
- Monitor status of submitted claims for timely reimbursement
- Conduct regular audits for regulatory and billing compliance
- Respond to patient inquiries regarding claims status
- Explain benefits and claims outcomes to patients
- Maintain and update patient records with claim and payment information
- Generate and analyze claim status, denial, and payment reports
- Identify and correct claim processing errors
- Stay updated on changes in insurance policies, coding guidelines, and regulations
- Handle appeals and re-submissions for denied or underpaid claims
- Collaborate with accounting and finance for payment reconciliation
- Train and support new team members on claims processing procedures
- Develop and implement strategies to improve claims processing efficiency

The ideal candidate for the Virtual Medical Claims Coordinator role is a highly meticulous and detail-oriented professional with over two years of experience in medical claims processing or healthcare billing. They possess a strong proficiency with medical billing codes (ICD-10, CPT, HCPCS) and have a thorough understanding of healthcare insurance policies and regulations, including compliance with HIPAA. The candidate is adept at using electronic health records (EHR) systems and claims processing software, and demonstrates exceptional data entry accuracy. Equipped with outstanding analytical and problem-solving skills, the individual is capable of generating and interpreting detailed claims reports to identify and address discrepancies. Strong communication skills, both verbal and written, enable them to effectively liaise with healthcare providers, insurance companies, and patients. The ideal candidate is highly organized, capable of managing multiple tasks and prioritizing them effectively, while maintaining detailed patient records with up-to-date claim and payment information. They are resourceful in researching and resolving claim discrepancies, and familiar with the appeals process for denied claims. With a commitment to regular auditing practices and staying informed about industry changes, they display adaptability and eagerness to improve claims processing efficiency. Additionally, they excel in customer service, handling sensitive and confidential information professionally, and providing training and support to new team members. Proficiency with Microsoft Office Suite, especially Excel and Word, further enhances their capability to perform the role efficiently.

- Review and process incoming medical claims for accuracy and completeness
- Verify patient insurance coverage and eligibility
- Communicate with healthcare providers to obtain necessary documentation and information
- Input claim information into the relevant database or claims processing system
- Adjudicate claims by determining whether to approve, deny, or request additional information
- Resolve discrepancies and follow up on pending or incomplete claims
- Utilize medical billing codes (ICD-10, CPT, HCPCS) for accurate claim processing
- Coordinate with insurance companies to clarify policy details and resolve issues
- Prepare and submit electronic and paper claims to insurance carriers
- Monitor the status of submitted claims to ensure timely reimbursement
- Conduct regular audits to ensure compliance with regulations and billing guidelines
- Respond to inquiries from patients regarding their claims status and explain their benefits
- Maintain and update patient records with claim status and payment information
- Generate and analyze reports on claim statuses, denials, and payments
- Identify and address claim processing errors to prevent future occurrences
- Stay updated on changes in insurance policies, coding guidelines, and healthcare regulations
- Handle appeals and re-submissions for denied or underpaid claims
- Collaborate with accounting and finance departments to reconcile payments
- Provide training and support to new team members on claims processing procedures
- Develop and implement strategies to streamline claims processing and improve efficiency

- Meticulous attention to detail
- Strong analytical skills
- Excellent communication abilities
- Proficiency in medical billing codes (ICD-10, CPT, HCPCS)
- Thorough understanding of healthcare insurance policies
- Experience navigating electronic health records (EHR) systems
- Aptitude for managing multiple tasks and prioritizing effectively
- Solid problem-solving capabilities
- Capability to work independently and in a team setting
- Strong organizational skills
- Commitment to maintaining accurate and detailed records
- Familiarity with the appeals process for denied claims
- Dedication to regular auditing practices
- Ability to handle sensitive and confidential information professionally
- Excellent customer service skills
- Resourcefulness in researching and resolving claim discrepancies
- Adaptability to industry changes and evolving processes
- Willingness to provide training and support to new team members
- Strong proficiency with Microsoft Office Suite, especially Excel and Word
- Eagerness to stay informed about healthcare regulations and billing guidelines

- Competitive salary range: $45,000 - $60,000 annually
- Health, dental, and vision insurance coverage
- Flexible working hours and remote work opportunities
- Paid time off (PTO) and holidays
- Retirement savings plan with company match
- Professional development opportunities and tuition reimbursement
- Wellness programs and gym membership discounts
- Life and disability insurance
- Employee assistance program (EAP) for personal and professional support
- Internet and technological equipment stipend for remote work
- Opportunities for advancement and career growth
- Regular training and upskilling programs
- Supportive team environment and company culture
- Performance-based bonuses and incentives
- Access to employee discount programs
- Company-sponsored team-building events and activities