Medical Claims Specialist – Full-Time Position – Remote – Must Reside in the Research Triangle Area, NC

We are a dynamic, fast-paced specialty medical practice committed to delivering exceptional care and service to our patients. We’re seeking an experienced, detail-oriented Medical Claims Specialist to join our team and help ensure accurate and timely processing of all insurance and billing needs.

Key Responsibilities:

- Review and submit medical claims to insurance carriers via electronic or paper billing systems.

- Verify insurance eligibility and benefits for patients.

- Investigate and resolve claim denials, rejections, and payment discrepancies.

- Coordinate with healthcare providers, coders, and billing staff to ensure proper documentation and coding.

- Follow up with insurance companies on unpaid or underpaid claims.

- Appeal denied claims in accordance with payer-specific guidelines.

- Maintain detailed records of billing activities and communications.

- Ensure compliance with HIPAA and payer-specific regulations.

- Assist patients with understanding their insurance coverage and balances if needed

Required Skills and Qualifications:

- Minimum 2 years of experience in medical claims processing or billing.

- Strong understanding of CPT, ICD-10, and HCPCS codes.

- Familiarity with EOBs (Explanation of Benefits), ERA/835 files, and payer portals.

- Proficiency in practice management software (e.g., Athena, Epic, Kareo).

- Excellent attention to detail, organization, and communication skills.

- Ability to work independently and meet deadlines.

What We Offer:

- Comprehensive health, dental, and vision coverage.

- Retirement plan with employer contributions.

- Paid Time Off program.

- Supportive team environment with room to grow.

- The chance to make a meaningful impact on patients’ access to care.