Specialist II, RCM Collections

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

📋 Description

• Investigate and resolve issues related to denied claims.

• Manage portal inquiries and make outbound calls to insurance representatives to determine the reasons for denials.

• Resubmit claims that contain errors by utilizing knowledge of CMS 1500 forms, coding, and policy discrepancies.

• Compose appeals for applicable claim denials while ensuring compliance with medical policies across all insurance carriers.

• Maintain accurate and current patient data within the software.

• Communicate with relevant personnel regarding any data inconsistencies.

• Prioritize claim denials according to the internal Claim Prio Model.

• Identify underlying issues and propose upstream solutions to decrease the rate of denied claims.

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

• Report to the Supervisor of Collections and work collaboratively with four Collections Follow-up Pods.

• Support the optimization of the Collections process to enhance access to mental healthcare.

⛳️ Requirements

• Minimum of 3 years of experience in Medical Billing.

• Ability to multitask and navigate through various systems effectively.

• Strong aptitude for learning and adhering to processes for resolution seeking.

• Excellent collaboration skills within a team environment.

• Experience in a startup environment focusing on mental health or billing/collections.

• Familiarity with CMS 1500 forms.

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

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

• Resume must be submitted in PDF format.

• 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 paid time off.

• Company-sponsored holidays.

• Company-wide Winter Break.

• Up to 18 weeks of paid parental leave.

• Stipend for new child expenses.

• Allocated weekly flexible time for personal self-care.

• Annual allowance for wellness and professional development.

• Pre-tax commuter benefits for team members working from hub locations.

• Support for home workspace setup.

• Meal benefits provided.

• Memberships for wellness programs.

• Access to virtual healthcare.

• Discounts on pet insurance where applicable.

• Global travel assistance available.