medical insurance clerk

Key Responsibilities

• Review, analyze, and resolve denied or rejected insurance claims.

• Identify trends or root causes of denials and take corrective actions.

• Contact insurance companies to follow up on unpaid or denied claims.

• Submit corrected claims and appeals as needed in a timely manner.

• Communicate with patients and internal departments regarding billing issues and authorization requirements.

• Accurately post remittances, adjustments, and rejections in the billing system.

• Maintain knowledge of payer guidelines, coding updates, and insurance regulations.

• Assist with claim submissions, verifications, and pre-authorizations when needed.

• Document all actions and communications in the patient or client account system.

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Qualifications

• High school diploma or GED required; associate degree or medical billing certification preferred.
• 1–3 years of experience in insurance billing, claims, or denial management.
• Strong knowledge of CPT, ICD-10, and HCPCS codes (especially for healthcare settings).
• Experience with electronic health records (EHR) and billing software (e.g., Epic, Cerner, Kareo, Athenahealth).
• Familiarity with commercial and government insurance payers (Medicare, Medicaid, BCBS, Aetna, etc.).
• Excellent attention to detail, problem-solving, and time management skills.
• Strong communication skills—both written and verbal.