Job Description
Job Summary We are seeking a dedicated and detail-oriented Medical Claims & Appeals Specialist to join our revenue cycle team. In this primarily remote role, the successful candidate will review, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends to maximize collections. Please note: While this is a Work-from-Home (WFH) opportunity, the successful applicant must live within the Greater DFW area and be available to come into the office occasionally for equipment pickup, training, team-building events, or as requested by management. Additional WFH details will be discussed during the interview process. Essential Duties & Responsibilities Claims & Denials Management: Analyze payer denials by denial groupers, research discrepancies, and prepare/submit formal appeals related to denied services. EOB Analysis: Review and interpret Explanation of Benefits (EOB) from payers to determine exactly how claims were processed and managed. Insurance Follow-Up: Proactively contact insurance carriers to check on the status of claims, appeals, and insurance verification. Account Resolution: Contact patients and/or third-party payers to resolve outstanding insurance balances and underpaid claims. Financial Adjustments: Make necessary account adjustments as required by specific health plan reimbursement guidelines. Cross-Functional Collaboration: Function as a professional liaison between clinical departments and the management team. Trend Identification: Identify and report on payer payment and denial trends to help improve overall collection rates. Additional Duties: Complete special projects and perform other duties as assigned by leadership. Qualifications Required Education & Experience Education: High School Diploma or equivalent. Experience: Minimum of 2 years of recent experience in medical claims recovery and/or collections. Specialized Experience: Demonstrated, hands-on experience in Physician Billing with a focus on actually drafting and submitting appeals. Language: Must be able to read, write, and speak English fluently.
salary: $23.63 - $23.64 per hour
shift: First
work hours: 6 AM - 4 PM
education: High School
Responsibilities
Claims & Denials Management: Analyze payer denials by denial groupers, research discrepancies, and prepare/submit formal appeals related to denied services.
EOB Analysis: Review and interpret Explanation of Benefits (EOB) from payers to determine exactly how claims were processed and managed.
Insurance Follow-Up: Proactively contact insurance carriers to check on the status of claims, appeals, and insurance verification.
Account Resolution: Contact patients and/or third-party payers to resolve outstanding insurance balances and underpaid claims.
Financial Adjustments: Make necessary account adjustments as required by specific health plan reimbursement guidelines.
Cross-Functional Collaboration: Function as a professional liaison between clinical departments and the management team.
Trend Identification: Identify and report on payer payment and denial trends to help improve overall collection rates.
Additional Duties: Complete special projects and perform other duties as assigned by leadership.
Skills
- Medical Billing
- Accounts Receivables
- Collections
Qualifications
- Years of experience: 2 years
- Experience level: Experienced
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact
[email protected].
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Work at office, Remote work, Shift work