Specialist II, RCM Collections

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

📋 Description

• Investigate and resolve denied claims by conducting thorough research.

• Perform inquiries via portals and make outbound calls to insurance representatives to clarify reasons for denials.

• Resubmit claims containing errors utilizing knowledge of CMS 1500 forms, along with data, coding, and policy discrepancies.

• Prepare appeals for relevant claim denials while complying with medical policies across all insurance providers.

• Verify that patient data in the software is precise and current.

• Communicate with the appropriate personnel regarding any data inconsistencies.

• Utilize the internal Claim Priority Model to prioritize claim denials effectively.

• Determine root causes of denials and recommend proactive solutions to mitigate future denial rates.

• Execute bulk corrections for claim denials affecting multiple clients with similar denial types.

• Report directly to the Supervisor, Collections, and collaborate with four Collections Follow-up Pods.

• Contribute to the enhancement of the Collections process to support access to mental healthcare.

⛳️ Requirements

• Minimum of 3 years of experience in Medical Billing.

• Ability to multitask effectively and navigate various systems.

• Strong aptitude for learning and adhering to processes to achieve resolutions.

• Excellent teamwork and collaboration skills.

• Experience working at a startup in the mental health or billing/collections sector.

• Familiarity with CMS 1500 forms.

• Comprehensive understanding of data, coding, and policy errors.

• Capability to comply with medical policies for all insurance carriers.

• Resume must be submitted in PDF format.

• Must have authorization to work legally in the United States.

🏝️ Benefits

• Extensive medical, dental, vision, life, and disability insurance coverage.

• Complimentary access to therapy through the Grow platform for employees in the US.

• Retirement savings options.

• Opportunities for equity participation.

• Flexible time off policy.

• Paid holidays provided by the company.

• Company-wide Winter Break.

• Up to 18 weeks of paid parental leave.

• Stipend for new parents.

• Dedicated weekly flexible time for self-care activities.

• Annual wellness and professional development stipend.

• Pre-tax commuter benefits available for employees working from hub locations.

• Support for home workspace setup.

• Meal benefits offered.

• Wellness membership options.

• Access to virtual care services.

• Discounts on pet insurance where applicable.

• Global travel assistance provided.