About MET Healthcare Solutions MET Healthcare Solutions is a growing healthcare administrative services company specializing in medical claims review, dispute resolution, and healthcare data and quality solutions.

We are looking for an experienced Medical Claims Eligibility Specialist II who understands the details behind a medical claimnot just how to enter or process one.

This position is ideal for a healthcare claims professional who is comfortable reviewing EOBs, payment remittances, medical claims, reimbursement information, and complex claim documentation and using that information to make accurate eligibility determinations.

If you have hands-on experience reviewing EOBs and understand how insurance payments, adjustments, denials, patient responsibility, and reimbursement rules work, we want to hear from you.

The Opportunity As a Medical Claims Eligibility Specialist II, you will play an important role in determining whether healthcare claims qualify for the federal dispute resolution process.

You will review claim documentation, analyze payment information, communicate with healthcare providers and health plans, and make detailed eligibility determinations based on federal regulations and MET Healthcare Solutions' established policies and procedures.

This is an analytical, detail-oriented position where your knowledge of medical claims and EOBs will directly impact the accuracy and success of our claims review process.

What You'll Do Review and analyze Explanation of Benefits (EOBs) and payment remittance documents to determine claim eligibility. Review medical claims and supporting documentation submitted by healthcare providers and insurance carriers. Analyze claim payment information, including billed charges, allowed amounts, payments, adjustments, denials, contractual reductions, patient responsibility, and other reimbursement information. Determine whether claims meet established requirements for the federal dispute resolution process. Review and interpret different @types of medical claims, including professional, outpatient, inpatient, surgical, anesthesia, and high-dollar/complex claims. Review HCFA/CMS-1500 and UB-92/UB-04 claim forms and supporting documentation. Apply knowledge of insurance reimbursement rules, including COB, DRG, RCC, and other applicable reimbursement methodologies. Identify missing, inconsistent, or incomplete information and communicate with providers and health plans to obtain the documentation needed to complete a claim review. Compose clear, professional correspondence explaining claim determinations and requesting additional information when necessary. Maintain accurate electronic and physical claim records. Track claim status and documentation across multiple operating systems. Stay current on applicable healthcare regulations, reimbursement requirements, and industry changes. Work independently while maintaining productivity, accuracy, confidentiality, and strict attention to detail. Communicate professionally with healthcare providers, insurance carriers/plans, and internal team members.

What We're Looking For Required Experience This is an experienced claims position. Candidates should have: -At least 2 years of hands-on medical claims experience. -Demonstrated experience reviewing and interpreting EOBs and payment remittances. -Strong understanding of how medical claims are processed and reimbursed. -Experience reviewing claims from both healthcare providers and insurance carriers. -Experience with multiple @types of medical claims, including professional, outpatient, inpatient, surgical, anesthesia, and complex/high-dollar claims. -Working knowledge of HCFA/CMS-1500 and UB-92/UB-04 claim forms. -Understanding of insurance reimbursement rules and methodologies. -Experience working with multiple computer systems and applications simultaneously. -Excellent written and verbal communication skills. -Strong analytical and problem-solving abilities. -Exceptional attention to detail and accuracy. -Ability to handle confidential healthcare information professionally and in accordance with HIPAA requirements.

Preferred Qualifications

-Bachelor's degree in healthcare administration, business, health information management, or a related field. -Medical Billing and Coding certification. -Experience with revenue cycle management. -Experience with accounts receivable, claims resolution, denial management, or payment posting. -Experience reviewing COB, DRG/RCC, surgical, anesthesia, and high-dollar claims. -Familiarity with healthcare reimbursement regulations and the No Surprises Act/federal dispute resolution process.

What Makes This Role Different At MET Healthcare Solutions, you won't simply be processing claims. You'll be using your claims knowledge and EOB expertise to analyze complex healthcare reimbursement information and make decisions that matter.

This role provides an opportunity to build deeper expertise in medical claims analysis, healthcare reimbursement, and the federal dispute resolution process while working alongside a team focused on accuracy, quality, and regulatory compliance.

Compensation and Benefits $23-$25 per hour, based on experience and qualifications

Full-time employees are eligible for: -Health insurance -401(k) with company matching -Paid time off (holiday, vacation and sick)

Monday-Friday schedule Consistent 8:00 AM-5:00 PM work schedule Professional and collaborative work environment Opportunities for continued growth and development

Schedule and Location Monday-Friday, 8:00 AM-5:00 PM This position is in-person at our Houston office: 2211 West 34th Street Houston, TX 77018 Our office is conveniently located just north of the Heights.

Important: Please Read Before Applying This position requires hands-on experience reviewing medical claims and EOBs.

Candidates whose experience is limited primarily to patient registration, scheduling, eligibility verification, medical records, or general administrative healthcare work may not have the claims-analysis experience required for this role.

We are specifically looking for someone who can look at an EOB/payment remittance and a medical claim and understand what the numbers, codes, adjustments, payments, and reimbursement information mean.

If that describes your experience, we'd love to hear from you.

MET Healthcare Solutions is an equal opportunity employer.

MEDICAL EVALUATORS OF TEXAS ASO LLC

Latest Jobs

Medical Claims