Claim Edit Specialist - Remote
About The Position
QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S., with over 150 locations across 17 states. Our purpose is to educate, protect, and care for skin, providing comprehensive skin care to help individuals achieve healthier and more beautiful skin. We are dedicated to educating communities and healthcare professionals on skin health, including skin cancer prevention and achieving healthy skin through annual exams. We aim to make high-quality skin care more accessible and timely while fostering a rewarding work environment. The Claim Edit Specialist is responsible for identifying and resolving third-party payer rejections, assisting in the resolution of edits/errors that may lead to nonpayment or prevent charge acceptance by payers. This role also involves entering bills/charges with input from the certified coding team when necessary.
Requirements
- Must have knowledge of claim correction, electronic claim submission
- Ability to contact payers when necessary to resolve any issues
- 1-3 years’ experience in a medical/insurance environment for physician practice or billing company
- Strict attention to detail
- Ability to meet deadlines in a fast paced, start-up, results-oriented environment, as well as excellent organizational skills
- Excellent verbal and written communication skills
- Proficient Microsoft Office Suite products, specifically Excel and ability to analyze large data sets
- Ability to collaborate and work in a team environment
- Applicants must be currently authorized to work in the United States in a full-time basis.
Nice To Haves
- Revenue cycle experience preferred
- Complete Modernizing Medicine University courses within 6 months of hire
Responsibilities
- Manage claims returned which have failed scrub rules
- Identify and resolve payer rejections in a timely manner.
- Enter charges/bills into EMR in coordination with certified coding team/Coding manager
- Monitor missing charges and communicate with RCM management as needed
- Report any trends in a timely manner to RCM leadership that prevent successful claim submission
- Ability to effectively communicate with other departments such as Coding, AR/Follow-up, Patient Services and Posting
Benefits
- Competitive Pay – Attractive compensation to reward your hard work
- Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered
- Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting
- Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year
- Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans
- Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances
- Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security
- Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges
- Exclusive Employee Discounts – Save on products and services with special discounts just for you
- Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
