Responsibilities
- Submit accurate insurance claims consistently across all service areas, adhering to strict timelines.
- Confirm claim accuracy by reviewing clinical records in Ritten.io, including visit notes, service dates, patient eligibility, and mandatory fields.
- Review daily clearinghouse outputs to detect rejected or erroneous claims and correct them swiftly.
- Adhere to payer-specific deadlines and internal billing cycles when scheduling claim submissions.
- Take accountability for managing denied, rejected, or unpaid claims, identifying root causes and ensuring proper resubmission.
- Engage directly with insurance payers to resolve issues involving authorizations, eligibility, coding, benefit coordination, missing documents, and technical errors.
- Coordinate with the clearinghouse to troubleshoot claim transmission failures, formatting problems, and routing discrepancies.
- Log all denial details, corrective steps, and payer interactions in internal tracking systems.
- Identify patterns in denials and report recurring issues to the Revenue Cycle Manager.
- Resubmit corrected claims within payer-defined timeframes.
- Compare claims data with clinical encounters in Ritten.io to verify documentation supports billed services.
- Ensure all necessary data points—such as encounter type, duration, location, care manager input, and required signatures—meet payer and CalAIM standards.
- Identify missing or incomplete documentation and notify care teams and management promptly.
- Support quality audits of clinical records and coding completeness to improve billing accuracy.
- Keep detailed billing records, denial logs, and accounts receivable aging reports up to date.
- Assist with monthly financial close tasks, including reconciliation of payments, adjustments, and open claims.
- Help generate performance reports on claim volumes, denial rates, payer behavior, and days in accounts receivable.
- Contribute to refining revenue cycle workflows, standard operating procedures, and billing policies.
- Coordinate with Authorization Specialists to confirm service approvals prior to claim submission.
- Communicate regularly with Care Managers, Supervisors, and Admissions staff to secure complete documentation for compliant billing.
- Provide actionable feedback to clinical staff on recurring documentation issues that delay claims processing.
- Attend revenue cycle meetings and training sessions to stay aligned with team goals and updates.
Work Arrangement
Remote (Worldwide)
Other
- Applicants must fully complete the application form.
- A recorded video submission is required as part of the application process.
- Successful candidates will receive an email outlining next steps; the video serves as the initial interview stage.
- Failure to submit a video will result in disqualification from consideration for any open positions.
