! Claim Edit/Rejections - Physician RCM

Strivant Health is moving to a 22K sq ft office space in Tinley Park, IL getting ready for expansion. Come join the growth!

Does this describe you?

  • Ability to excel - As both a student and teacher
  • Open minded - We value opinions and contributions from every member of the team
  • Great attitude - We can’t teach that stuff!
  • Go-Getter Mindset - Willingness to go the extra mile to get the job done

If so, we'd like to hear from you. We are looking for like-minded individuals to become part of our dynamic, enthusiastic and growing team! Please submit your resume today.

Who we are:

Strivant Health's foundation was created in 1996 (Lonestar MSO) on the idea of perfecting the business of medicine and revenue cycle management by using better people, processes and technology. Today we provide best in class Medical Billing, Collections, Call Center, Credentialing and Analytics that are all designed to focus on maximizing our provider clients’ revenue. This allows our client providers to stay focused on the practice of medicine, rather than the business of medicine. We have worked with over 4,000 providers representing 25 different specialties and over 30 technology platforms in our 20+ years of business.

Benefits: Strivant Health offers its employees excellent benefits including Health, Dental, Vision, Life, AD&D, paid holidays and PTO, 401(k).

TITLE: Claim Edit/Rejections Specialist - Physician Revenue Cycle Services

LOCATION: 18670 Graphics Drive, Tinley Park, IL 60477

HOURS: Standard business hours, Monday - Friday

STATUS: Full Time, benefits eligible

SUMMARY

The Claim Edit/Rejections Specialist is responsible for the processing and monitoring of claim edits. The Claim Edit Representative also ensures claims are correct by analyzing systems edits, claim form requirements and rejections. Reconciles and audits edit corrections. Responsible for identifying inappropriate edits and forwards them to the appropriate internal teams, client or insurance carriers to resolve edits. This position holds additional duties with respect to research, and participation in root cause analysis and identifying process improvements. As well as, participation in employee training and quality audits, with possible exposure to multiple practice management systems.

ESSENTIAL FUNCTIONS:

  • Resolve daily clearinghouse edits
  • Resolve daily host system claim form edits
  • Resolve edits within systems’ work ques, retro, etc.
  • Resolve Statement/Return Mail address edits
  • Print Medical Records/Documentation
  • Contact various insurance carriers to resolve edits
  • Responsible for reviewing accounts, verifying eligibility, updating registration, rebill activities and leaving detailed account notes
  • Meets or Exceeds Department Productivity standard 20 invoices/hour depending on client worked
  • Meets or Exceeds Quality Assurance standard of 95% or higher
  • Communicate with clients via email
  • Analyze and resolve moderately complex claim edit reconciliations, reviews entry to prevent errors
  • Maintains a desk as well as serve as just-in-time staffing, working inventory for team members that may be absent or backlogged.
  • Research and obtain required documents to resolve misdirected claim edit issues
  • Assist in employee training and mentorship
  • Independently identifies root cause issues and effectively resolve complex claim edit issues; categorize error reasons and coordinate with management or other team members to ensure process improvements are completed
  • Completes reports and resolve high priority claim edit issues
  • Provide technical assistance, coaching and training to other team members
  • Provides periodic quality assurance checks
  • Assist in special projects assigned by management.
  • Participate and attend meetings, training seminars and in-services to develop job knowledge.
  • Respond timely to emails and telephone messages from the staff and management.
  • Performs other related duties as required or requested.

REQUIREMENTS:

  • High School diplomas or equivalency
  • A minimum of 3 years of general office experience, specifically within roles requiring high volume numeric data entry with a focus on accuracy required.
  • A minimum of 1 years of medical billing or accounts receivables experience, or related schooling
  • Prior experience translating claim edit trends into process improvements results with little supervision
  • May be required to pass a typing and numeric entry pre-employment test
  • Ability to effectively use a personal computer and working knowledge of spreadsheet application to perform data entry and analysis (must be proficient in Excel and Word).
  • Communication and interpersonal skills necessary to interact with internal/external customers in various circumstances.
  • Ability to collaborate effectively in a team setting to maximize quality and efficiently of operations.
  • Excellent organizational and time management skills. Ability to establish and meet deadlines while managing multiple priorities.


We are looking forward to reviewing your resume!

No agencies, please

Location
Tinley Park IL
Job Type
Full-Time Regular
Exempt or Non-Exempt?
Non-Exempt
Hours
Standard Business Hours
Scheduled Days
Monday - Friday
Position Id
201131