IDR Claim Specialist

Gryphon Healthcare • Houston, TX

4d • Onsite

About The Position

Federal IDR Claim Specialist is responsible for analyzing, organizing, and preparing documentation for eligible claims to be filed with Federal IDR in effort to promptly resolve billing disputes between out of network providers, facilities, and health plans. This role manages disputes between out-of-network health care providers and health plans (Arbitration) and disputes between out-of-network facilities and health plans (Mediation).

Requirements

• High School graduate or equivalent required.
• Previous experience in medical billing preferred.
• Ability to accurately interpret Eligibility of Benefits (EOB)
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations
• EMR, EDI and Commercial Insurance Company systems
• Ability to represent the company in a professional manner and handle patient issues with sensitivity and confidentiality.
• Detail oriented and accurate data entry skills
• Strong organizational skills and the ability to prioritize workload
• Must be able to write and speak effectively in English
• Must demonstrate interpersonal skills with all levels of the billing and management team
• Must be able to work well in a team environment
• Must have basic computer literacy that includes keyboarding skills with the ability to utilize Outlook and to navigate in a Windows environment.

Nice To Haves

• Strong interpersonal and communications skills to be able to work successfully in a team-oriented environment.
• Active participant within the team and contributes to achieving team objectives
• Able to communicate information and ideas in a clear concise manner both orally and in written form.
• Able to convey complex information clearly.
• Takes time to listen to and understand the perspective of others and propose solutions.
• Understands and fully utilizes computer systems used in the technological stream of researching and entering claim information including but not limited to: Centricity, Microsoft Office Suite, Smartsheets
• Well organized, self-motivated, and able to work with minimal supervision, meet quality and productivity standards
• Demonstrates behaviors consistent with the organization’s core values.
• Displays an appearance in compliance with the dress code policy
• Accepts responsibility for one’s own decisions, actions, and failures.
• Demonstrates knowledge, skills, and ability to determine right from wrong.

Responsibilities

• Work daily reports to identify claims eligible for Mediation/Arbitration by identifying insurance type, eligible dates of service and EOB check dates.
• Prepare Arbitration/Mediation documentation packets for filing with IDR by compiling required components, review for accuracy and recording and uploading to appropriate drive/system.
• Record and track all required case information via applicable system (i.e. Smartsheets, Excel, Word).
• Identify and communicate IDR trends with Director of Revenue Cycle Management & Legal Team.
• Participates in team meetings and provides input and feedback to support Legal Team goals, objectives, and timelines.
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations.
• Perform all other duties and tasks assigned by Management.
• Provides support as needed to all members of the billing and auxiliary departments at Gryphon Healthcare.
• Demonstrates good customer service standards when communicating with internal and/or external customers.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED