Claim processing specialist job description

Professional Physical Therapy is a leading provider of outpatient physical therapy and rehabilitation services in the Northeast and a certified Great Place to Work . We are seeking a Claims Processing Specialist. The Claims Processing, Billing Specialist is responsible for reviewing and processing all claims from the billing system and the clearinghouse. Responsible for working exception and rejection reports to ensure claims get cleared and processed to payer in a timely manner.
Principal Duties and Responsibilities:

* Works claims to clear edits, scrub for errors or rejections and ensure claims get processed to payer for payment.
* Ensures accounts are processed and submitted to payers.
* Identifies billing issues within Raintree Billing System and the clearinghouse; escalates as necessary and resolves issues to ensure claims are submitted.
* Behaves in a manner consistent with Professional's mission, vision and values.
* Maintains a working knowledge of HIPAA, OSHA, Risk Management and compliance regulations.
* Attends Company meetings as required.
* Attends training classes as directed and completes assigned training courses.
* Practices confidentiality in accordance with Company policies and all laws and regulations.
* Other duties as assigned.
* Stays abreast of laws and regulations affecting reimbursement.

Qualifications:

* 5 years of health care experience preferred, with strong emphasis on front-end insurance verification, authorization management and point of service collections processes.
* Demonstrated skills in revenue cycle management and problem solving skills.
* Strong organizational and time management skills are required.
* Establishes a collaborative environment capitalizing on employee talents, experience, interests, and diversity to reach high performance.
* Embraces diversity within the work environment and consistently deals with internal and external customers in a friendly and respectful manner; supports teamwork and cooperation with work partners in daily activities.
* Excellent analytical and problem-solving skills.
* Excellent communications skills are required.
* Ability to work independently and follow-through and handle multiple tasks and/or special projects simultaneously.

This position is partially remote and partially in office. To work from home you must be within commuting distance of Melville, NY and

* Must have adequate internet connection to support uninterrupted service with a speed of at least 100mbps works remote only using assigned equipment.
* Must have a quiet, private workspace location within the employee's home.
* May be required to sit or stand for long periods of time.

Must be available to come to the office for meetings and training. Also must come in the office at least once a week to print out the claims Location: Melville, NY

Professional provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

AssistRx has engineered the perfect blend of technology and talent to provide life sciences companies with an efficient solution to improve patient uptake, visibility and outcomes. Our talented team members provide therapy and healthcare system expertise to help patients achieve better results from care. As a growing organization, AssistRx views our people as our strongest asset. Join us as we continue to make a difference....

The Copay Support/Claims Processing Specialist is a critical role within the organization and is responsible for servicing inbound calls, EOB faxes, and mail (emails, USMail) from pharmacies, patients, Sites of Care, Health Care Providers, copay vendors (PDMI, FHA and Merchant Card processors) and other sources. Required engagement is with pharmacy claim adjudicators, third party medical claim administrators, merchant vendors, finance for manual claim reimbursement, Sites of Care and Health Care Providers.

The Copay Support/Claims Processing Specialist will adjudication, troubleshoot claim rejections, claim reversals, allocation deficiencies, identifying group accumulator and maximizers, provide alternate payment processing method, handle paperwork related to medical procedures, treatments and services submitted by the site of care or health care providers that meet the program business rules for determination of approval, denial, or pending for submission of required information for final determination as well as claim appeal handling.

The Copay Support/Claims Processing Specialist will also partner with Copay Support Lead, program managers, finance team members and other departments within the organization to assist in supporting all operational and financial processes related to claim processing activities.
Requirements

High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.

Associate's Degree (AA) or equivalent from a two-year college or technical school, or six months to one year related experience and/or training, or equivalent combination of education and experience.

Computer skills required: Contract Management Systems; Microsoft Office

Other skills required: Pharmacy Data Management (PDMI), PNC Card Platform

Benefits

Supportive, progressive, fast-paced environment

Competitive pay structure

Matching 401(k) with immediate vesting

Medical, dental, vision, life, & short-term disability insurance

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.

HealthPro Medical Billing, Inc.
of
Lima, OH
is seeking to hire an
onsite or remote full or part-time
medical
Claims Processing Specialist
to work denials, ignored claims, and delinquent claims. We offer a flexible work environment that encourages
family life and work balance
.

Our employees enjoy full benefits including
health, dental, vision, paid time off, 401k, incentive bonuses,
and
continued education
. If this sounds like the opportunity that you've been looking for, apply today!


ABOUT HEALTHPRO MEDICAL BILLING, INC.


HealthPro Medical Billing is the trusted partner of choice for radiology and pathology practices, as well as imaging centers and other healthcare service providers throughout the United States. Now in business for over 38 years, our success is fully dependent on the service and results we provide our clients and the integrity we demonstrate along the way. Because building and maintaining client trust is essential to our business, we seek out talented medical billing professionals who share our
commitment to quality
.

Our
excellent service, care, and compassion
for our clients and team members set us apart in the industry. Here at HealthPro,
we genuinely care
about our clients' and team members' success. Our foundation is built on integrity, commitment, and accountability. If you're looking for a team that will
value your professional skills
as well as your personal integrity, you may have a future with us.


A DAY IN THE LIFE AS A CLAIMS PROCESSING SPECIALIST


As a Claims Processing Specialist, you analyze, evaluate, and resolve claims efficiently using written appeals, online claim corrections, websites, and phone calls to insurance companies, facilities, or provider representatives. You communicate with payers, clients, and hospitals to resolve issues and identify trends, problems, and concerns that contribute to negative client reimbursement. You maintain compliance with payer guidelines and governmental regulations. You work accounts receivable/collection write-offs to remove uncollectable accounts per company guidelines and you assist with statistical reports. Your excellent analytical and decision-making skills are essential to your success. You enjoy being a part of our Claims Processing team!


QUALIFICATIONS

• Understanding of the billing process and terminology
• Previous experience in claims processing is preferred
• Analytical and decision-making abilities
• Strong attention to detail and organizational skills
• Excellent written and oral communication skills
• Certification or associate degree in a related area of study preferred OR a minimum of 3 years of medical billing experience.

Are you analytical, a good decision-maker, and reliable? Do you have excellent communication and customer service skills? Are you determined to solve problems? If so, you may be perfect for this position!


WORK SCHEDULE


The typical schedule for this position is Monday through Friday from 7:00 a.m. to 3:30 p.m., but
hours are flexible
.


ARE YOU READY TO JOIN OUR HEALTHPRO TEAM?


If you feel that you would be a great fit for this position, please fill out our initial
3-minute, mobile-friendly application
and complete the 20-minute assessment process so we can review your information. We look forward to meeting you!

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