We are seeking a highly organized and detail-oriented Claims Review Specialist to join our team at BMMSA. As a Claims Review Specialist, you will play a crucial role in handling and reviewing insurance claims to ensure accuracy and compliance with established guidelines. Your attention to detail, analytical skills, and knowledge of medical billing and coding will be essential in this position.
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Conduct thorough reviews and analyze various types of insurance claims to identify errors, discrepancies, and potential fraudulent activities
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Verify the accuracy of medical codes, diagnoses, and procedure descriptions on claims to ensure compliance with coding guidelines and regulations
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Collaborate with medical professionals, insurance companies, and internal departments to resolve claim discrepancies and provide necessary documentation
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Research and interpret insurance policies, regulations, and industry guidelines to determine the validity of claims and make appropriate adjustments or denials
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Maintain accurate records of claims reviews, outcomes, and any additional documentation required for auditing purposes
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Assist in the development and implementation of quality assurance programs to improve claims management processes and minimize errors
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Stay up-to-date with changes in insurance regulations, coding guidelines, and medical procedures to continually enhance knowledge and ensure compliance with industry standards