Billing and Claims Specialist

Rightway•Denver, CO

4d•Onsite

About The Position

This role is located in our Denver Tech Center Office. This is not a remote position. WHAT YOU'LL DO: Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners Initiates investigation of questionable claims Resolves medical, dental, and vision claims and billing questions and issues by examining the summary of benefits contacting the carrier and/or the provider billing office to ensure the member is not being overcharged calculating out-of-pocket costs based on benefits initiating reimbursement requests with the carrier composing appeal letter Provides information on year-to-date deductible, copay, and coinsurance activity to team members Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner Protects claimant information by following HIPAA guidelines Reports claim status updates in proprietary CRM and provides detailed information on each claim WHO YOU ARE: Our Navigation Operations is a fast-paced, dynamic, and growing environment. We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers.

Requirements

Strong communication skills, both written and verbal
Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication
Strong demonstration of critical thinking and problem-solving skills
Bachelor’s degree in health sciences or related field and minimum of 2 years of experience as a medical claims specialist preferred

Responsibilities

Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy
Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners
Initiates investigation of questionable claims
Resolves medical, dental, and vision claims and billing questions and issues by examining the summary of benefits
Resolves medical, dental, and vision claims and billing questions and issues by contacting the carrier and/or the provider billing office to ensure the member is not being overcharged
Resolves medical, dental, and vision claims and billing questions and issues by calculating out-of-pocket costs based on benefits
Resolves medical, dental, and vision claims and billing questions and issues by initiating reimbursement requests with the carrier
Resolves medical, dental, and vision claims and billing questions and issues by composing appeal letter
Provides information on year-to-date deductible, copay, and coinsurance activity to team members
Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
Protects claimant information by following HIPAA guidelines
Reports claim status updates in proprietary CRM and provides detailed information on each claim