Claim Review Specialist

Summary

Join Carda Health, a leading virtual heart clinic, as our Claim Review Specialist! You will play a crucial role in ensuring maximum reimbursement and compliance by owning and improving our claims review process. Collaborate with clinical and administrative staff to optimize our billing process for efficiency and accuracy. This role requires strong knowledge of medical coding (CPT, ICD-10, HCPCS) and experience in healthcare claims processing. You'll be responsible for reviewing claims, identifying errors, ensuring payer compliance, and implementing process improvements. We seek a meticulous and detail-oriented individual passionate about healthcare finance and committed to improving patient care.

Requirements

• Ability to work during a United States time zone
• 2+ years of experience in healthcare claims processing or medical billing with a track record of improving clean claim rates
• Strong knowledge of CPT, ICD-10, and HCPCS coding
• Experience with insurance verification and prior authorization processes
• Ability to work in a fast-paced environment with changing priorities
• Highly collaborative and excellent written and oral communication skills. It is imperative you are able to clearly and effectively interact with members of our team in a remote environment
• Inherent growth mindset: you are always focused on improving faster and getting the team to do the same
• Ability to track and report on key metrics that define your success including clean claim rate, denial rate, and days in A/R

Responsibilities

• Reviewing medical claims before submission to identify and correct errors
• Ensuring claims meet payer-specific requirements and billing guidelines
• Verifying proper coding (CPT, ICD-10, HCPCS) on claims
• Checking for missing information or documentation
• Identifying potential claim denials before submission
• Correcting claim errors or returning them to appropriate staff for correction
• Monitoring claim rejection patterns and implementing process improvements
• Staying current with insurance requirements and coding regulations
• Communicating with providers and billing staff about documentation needs
• Maintaining high accuracy rates for clean claim submissions

Preferred Qualifications

• Certification in medical coding (CPC, CCS, etc.)
• Experience with virtual or telemedicine billing
• Experience with cardiac care or rehabilitation billing
• Experience and desire to work remotely (our whole team is remote)
• Prior experience using technology tools including GSuite, electronic health records, and claims processing software
• Prior experience using technology tools including GSuite, ZenDesk, Slack