While you take care of your patients’ physical health, it’s your medical claims specialist/examiner who takes care of their financial health. To help you find a well-qualified candidate, you have to put an abundance of thought and time into your job description. If not, you risk wasting several hours sorting through the application materials of unqualified individuals who may have been mislead by your poorly formatted job description. To save you time and frustration, it’s a good idea to check out a medical claims specialist/examiner job description sample.
Medical Claims Specialist/Examiner Job Summary
As the medical claims specialist/examiner of the Silverthorne County Medical Mall, you’ll determine whether patients have insurance coverage and help them with their medical claims. You’ll also make sure all actions taken are thoroughly documented and that you adhere to our policy of delivering quality customer service to each of our patients and their families. You must also ensure 100 percent legal and industry compliance throughout the entire claims process.
Medical Claims Specialist/Examiner Job Responsibilities & Duties
- Examine claims records and forms to determine whether the patient has medical insurance.
- Review provisions of certificate or policy to determine the patient’s included medical coverage losses.
- Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable.
- Complete logs, reports, forms and records to properly document medical claims.
- Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims.
- Adhere to all company policies, procedures and guidelines in addition to insurance regulations at the federal and state level.
- Examine medical treatment records, police reports, physical property damage and medical bills to gauge overall extent of liability.
- Interview and communicate with claimants, police, witnesses, physicians and other necessary individuals to decide claim denial, settlement or review.
- Ensure all claims information remains confidential.
- Engage in continuing education and training opportunities when possible.
Medical Claims Specialist/Examiner Skills & Qualifications
- At least a bachelor’s degree
- At least three years of experience working in the medical field
- At least two years of experience as a medical claims specialist/examiner
- Detail oriented
- Interpersonal skills
- Analytical abilities
- Data entry skills
- Knowledge of FDA health regulations
Started in 2000, the Silverthorne County Medical Mall was designed to take care of a wide variety of patient needs all in one central location. Our aim is to provide the absolute best medical services in an efficient yet thorough manner designed to meet all patient health needs. We use cutting edge technology throughout our Silverthorne facilities to treat patients, retain medical information, diagnose patients and handle medical payments. Our medical services are also designed in a way that’s affordable to those with and those without insurance. We don’t believe patients should have to go bankrupt in order to take proper care of their health.
Best Practices for Writing a Job Description
If you feel that the above medical claims specialist/examiner job description sample simply doesn’t apply to your unique situation, don’t despair. There are a few best practices for you to bear in mind while crafting your job description to ensure you stand the best chance of attracting the type of candidate who is the perfect match for your company or practice.
DO remember to use specific language throughout your job description. This helps paint a clear picture of how applicants can expect to spend their time on a daily basis. Direct language also helps eliminate unqualified candidates.
DON’T forget to add a few points about your company culture throughout the job description. While a potential applicant may be well qualified for the position, he or she may not have the right personality that complements your current workforce.
DO include the geographic location of your practice or business in order that candidates know how far they’ll have to travel to and from work. What’s more is that you should also mention whether you’re open to hiring out-of-state applicants and if you’ll compensate them for their moving expenses.
DON’T add anything about salary or benefits if doing so would risk breaking company policy. You don’t want to jeopardize your position while attempting to fill another.
DO be sure to include contact information and a call to action at the bottom of your job description. Let applicants know the type of submission materials you desire and how long they have to apply.
Medical Claims Specialist Job Responsibilities
There are a few tricks to writing the job responsibilities section of your medical claims specialist job description to make it more enticing to your ideal candidates. Start by arranging your information into bullet points. Because a good medical claims specialist should value organization, using this format can appeal to readers who appreciate structure in addition to making it easier to read. Begin each point by using an action verb to demonstrate the activities necessary each day and give potential applicants a convincing glimpse of what they would be doing as your employee. To avoid scaring away qualified candidates by making the job seem overcomplicated, list only 6-8 responsibilities.
Medical claims specialists may already have a general idea of the daily duties they would need to perform, so try to be as specific as possible in your medical claims specialist job description to give them an understanding of what it would look like to work for your company specifically. Be sure to emphasize any tasks that are unique to your company or not typically required of this type of position.
Look over these example medical claims specialist job responsibilities to assist you in writing your own:
- Examine patients’ medical records to ensure accuracy and completeness
- Operate classification software to apply the correct clinical codes for reimbursement
- Document patients’ health information, including medical history, examination and test results, and any treatments or procedures provided
- Preserve confidentiality of all patient records
Medical Claims Specialist Job Specifications
When writing your posting, you might need to sit down with the management team and decide which skills are helpful for a medical claims specialist to have and which ones are deal-breakers. You can create one list for each of these categories to enable readers to clearly decide whether they would be an ideal candidate. A strong job qualifications and skills section can make your medical claims specialist job description more enticing to qualified professionals.
When choosing skills to list in this section, consider including some personality traits. Medical claims specialists routinely work with doctors, nurses and other healthcare professionals, and it can be beneficial to find candidates that interact well with others.
If your company offers on-site training, consider tailoring your medical claims specialist job description towards applicants with a more general knowledge base, since this will increase your pool of potential applicants and you can give additional training as necessary. The increasing use of electronic health care records means it could be helpful to hire someone who has experience working with computers.
Take a look at these medical claims specialist job specifications for examples of what to include in yours:
- Associate’s degree in health information technology
- Certified Registered Health Information Technician
- Proficient with electronic health records computer software
- Excellent social and communication abilities
- Outstanding analytical and critical thinking skills