Claims & Billing Specialist

Rightway • Denver, CO

3d • Onsite

About The Position

This role is located in our Denver Tech Center Office. This is not a remote position. The Claims & Billing Specialist determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy. They extract additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners. This role initiates the investigation of questionable claims and resolves medical, dental, and vision claims and billing questions and issues. The specialist provides information on year-to-date deductible, copay, and coinsurance activity to team members. They maintain quality customer service by following customer service practices and responding to customer inquiries in a timely manner. Additionally, the role protects claimant information by following HIPAA guidelines and reports claim status updates in proprietary CRM, providing detailed information on each claim.

Requirements

• Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication
• Strong demonstration of critical thinking and problem-solving skills

Nice To Haves

• Bachelor’s degree in health sciences or related field
• Minimum of 2 years of experience as a medical claims specialist

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
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level