Remote Claim Edit Specialist - Physician Revenue Cycle Management

Strivant Health is a fast-growing Medical Billing/Revenue Cycle Management company. We partner with physician practices to improve revenue cycle operations by optimizing people, processes, and technology. We provide Medical Billing, Collections, Call Centers, Cash Applications, Patient Access, Authorizations, Credentialing, and Analytics designed to maximize 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 10,000 providers representing 32+ specialties and over 30+ technology platforms in our 20+ years of business.

LOCATION: Remote

Hours: Monday - Friday, 8:00 AM - 4:30 PM, full-time

Status: Full-Time, standard schedule is 40 hours a week

Benefits:
We offer BCBS plans for health, dental, and Vision through EyeMed. We also have company-sponsored life Insurance, plus voluntary STD, LTD, critical illness, ID theft, travel insurance, 401(k), and much more. Benefits start the first of the month following your hire date.

Claim Edit Specialist - Physician Revenue Cycle Management

The Claim Edit 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. They reconcile and audit edit corrections. Responsible for identifying inappropriate edits and forwarding them to the appropriate internal teams, clients, or insurance carriers to resolve edits. This position holds additional duties with respect to research, 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 queues, 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 the 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, review entry to prevent errors
  • Maintains a desk as well as serves 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.
  • Stay informed of changes in the procedures and laws for the specific insurance carriers or payers.
  • Assist in special projects assigned by management.
  • Participate in meetings, training seminars, and in-services to develop job knowledge.
  • Respond timely to emails and telephone messages from the staff, management, and the client.
  • May assist with accounts receivables, claim denials, charge entry, cash research, and payment posting, as needed.
  • Effectively communicate issues to management, including payer, system or escalated account issues, and develop solutions.
  • Remote Incumbents are required to adhere to the Company Telecommute Remote Work Location Policy.
  • 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 year of medical billing or accounts receivables experience or related schooling
  • Prior experience translating claim edit trends into process improvement 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 applications 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 efficiency of operations.
  • Excellent organizational and time management skills. Ability to establish and meet deadlines while managing multiple priorities.

Strivant Health provides equal employment opportunities to all qualified individuals regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, age, national origin, physical or mental disability, military or veteran status, genetic information, or any other protected classification. At Strivant Health, we conform to the spirit and the letter of all applicable laws and regulations.

We are looking forward to reviewing your resume!

No agencies, please!

Search tags: Customer Service Rep, Patient Access, Patient Financial Rep, Scheduling Rep, Revenue Cycle, RCM, Accounts Receivables Rep, Patient Account Rep, Patient Service Rep, Account Rep, Medical Coding, Medical Credentialing, Medical Referrals, Medical Billing, Physician


Job Type: Full-time

@StrivantHealth

Location
Remote
Job Type
Full-Time Regular
Exempt or Non-Exempt?
Non-Exempt
Hours
8:00 AM - 4:30 PM
Scheduled Days
Monday - Friday
Position Id
201629