Get It Recruit – Healthcare Hiring for Patient Support Medical Biller/Claims Processing Representative – Remote | WFH at Philadelphia, PA Full Time

We are thrilled to announce an exciting opportunity for a 100% remote (work from home) Patient Support Medical Claims Processing Representative to join our dynamic team. In this role, you will play a vital part in providing payment assistance solutions, such as co-pay cards or vouchers. As the Patient Support Call Center Representative, your primary focus will be on receiving medical claims from Healthcare Providers (HCPs) or patients, carefully vetting each claim against program-specific business rules to determine its eligibility for payment or rejection.

Key Responsibilities

Receive medical claims from HCPs or patients, ensuring the submission of adequate supporting documentation.

Interpret Explanation of Benefits (EOB)/CMS1500 and meticulously vet claims against program-specific business rules.

Make informed decisions on whether a claim should be approved or rejected.

Demonstrate exceptional organizational skills in managing and processing claims efficiently.

Provide support for customer inquiries via telephone, email, fax, or other available channels to the Support Center.

Recognize operational challenges and proactively suggest recommendations to management when necessary.

Work 40 hours per week, following two shifts: 8:30 am EST to 5:30 pm EST or 11:00 am EST to 8:00 pm EST, under moderate supervision.

Minimum Education And Experience

High School Diploma or equivalent.

Experience In Claim Processing Is Required.

Medical Billing and Coding Certification is mandatory.

Ability to interpret Explanation of Benefits (EOB).

HIPAA certification is a prerequisite.

Customer Service Experience Is Preferred.

Pharmacy Technician experience is also considered a valuable asset.

This role will be on a contractual basis managed by an external agency with the potential for conversion to a full-time position with IQVIA. If you are a motivated individual with a keen eye for detail and a passion for delivering excellent service, we invite you to join our team and contribute to the success of our patient support initiatives.

Employment Type: Full-Time