Revenue Cycle Claims Associate II

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess initial and ongoing insurance eligibility for patients and confirm coverage.

• Investigate and rectify patient accounts within Epic, including demographic, financial, and guarantor details.

• Communicate with insurers and third-party payers to secure and document necessary authorizations.

• Research and resolve missing or incorrect account information using various portals and resources.

• Conduct outreach efforts to identify unidentified payers.

• Review and modify claims and appeals prior to their submission to the clearinghouse.

• Analyze, investigate, and resolve claim discrepancies following federal, state, and payer guidelines.

• Monitor work queues for claims that need further investigation and resolution actions.

• Provide CRM assistance and manage documentation in OnBase for the TOQ department.

• Correct claims that have been rejected by claim scrubbers, clearinghouses, or payers.

• Examine explanations of payment and address denials through appeals, adjustments, or statements.

• Validate new workflows and manage assigned work queues until setup validation is complete.

• Investigate underpayments from payers and follow up via phone on unpaid aging claims.

• Supply supporting documentation to insurance payers.

• Accurately and timely perform write-offs for uncollectible accounts.

• Offer ad hoc departmental assistance, including involvement in special projects and support during outages or high-volume periods.

• Uphold confidentiality and adhere to HIPAA regulations and the company’s Quality Management System.

• Stay informed about medical billing regulations, rules, and guidelines.

• Relay insurance information to ancillary departments and reimbursement operations teams.

• Work autonomously and collaboratively while upholding quality and productivity standards.

⛳️ Requirements

• High School Diploma or General Education Degree (GED) is required.

• A minimum of 1 year in a revenue cycle position.

• At least 3 years of experience in medical billing, claims, and/or insurance processing.

• Comprehensive and up-to-date knowledge of government, managed care, and commercial insurance claim submission requirements, reimbursement guidelines, and denial reason codes.

• Familiarity with medical terminology and health insurance concepts.

• Understanding of EHR operating systems and electronic records.

• Proficient computer skills and strong keyboarding abilities.

• An acute attention to detail and a commitment to quality output.

• Capability to perform essential tasks with or without reasonable accommodation.

• Authorization to work in the United States without sponsorship.

• Availability to work Monday through Friday during standard business hours.

• Ability to work in front of a computer screen and/or engage in typing for around 90% of a typical workday.

• Ability to use a computer and phone simultaneously.

• Proficient in using a telephone with a headset.

• Successful completion of an assessment demonstrating understanding of Exact Sciences Epic processes with a minimum score of 80%.

• Preferred: Related Associate's degree or medical billing certification.

• Preferred: Over 5 years of experience in medical or insurance billing.

• Preferred: Experience with Epic or another EHR application.

🏝️ Benefits

• Opportunity to work remotely.

• Standard Monday–Friday work schedule.

• Reasonable accommodations available for employees with disabilities.

• No travel required.