About the Role
This role is responsible for managing complex claim submissions, resolving billing discrepancies, and ensuring compliance with payer requirements to optimize reimbursement for services rendered.
Responsibilities
- Review and validate patient eligibility and benefits for accurate claim processing
- Investigate and resolve claim denials and rejections from insurance carriers
- Collaborate with clinical and administrative teams to gather necessary documentation
- Ensure claims comply with federal, state, and payer-specific regulations
- Follow up on outstanding claims to expedite payment
- Maintain detailed records of claim status and resolution activities
- Communicate with payers to clarify coverage policies and resolve disputes
- Identify trends in claim rejections and recommend process improvements
- Support audits by providing accurate and timely claim data
- Assist in training team members on claim procedures and system updates
- Monitor key performance metrics related to claim accuracy and timeliness
- Process retroactive authorizations and adjustments as needed
- Verify coding accuracy in relation to claim submissions
- Escalate complex cases to appropriate departments when necessary
- Utilize claims management systems to track and update case statuses
- Ensure patient financial responsibilities are correctly calculated
- Respond to internal inquiries regarding claim status and resolution
- Maintain confidentiality of patient and financial information
- Stay current with changes in payer policies and regulatory requirements
- Support implementation of new billing workflows and system enhancements
- Coordinate with referral and scheduling teams to confirm service authorization
- Assist in reconciling payer remittances and adjustments
- Prepare reports on claim performance for leadership review
- Facilitate smooth transitions of patient accounts between care stages
- Promote accuracy and efficiency across the revenue cycle
Compensation
Competitive salary based on experience with comprehensive benefits package
Work Arrangement
Hybrid work model with a combination of remote and on-site presence
Team
Part of a centralized revenue cycle team supporting multiple care locations
About Us
We are a national healthcare organization integrating pharmacy and medical services to improve patient outcomes through coordinated care.
Why This Role Matters
Accurate claim processing directly impacts patient access to care and financial sustainability of clinical operations.
Not available for this position
