Claims Examiner

Summary

Join Integra as a Claims Examiner specializing in complex rehab technology (CRT). This role involves real-time support for CRT providers, navigating billing complexities with payers and internal teams. You will collaborate extensively, solve problems, and drive results. The ideal candidate possesses strong problem-solving and process management skills, along with a passion for healthcare. A competitive salary and comprehensive benefits package are offered. The position requires significant experience in medical claims processing and CRT billing, along with specific certifications. Integra offers remote work opportunities in various states.

Requirements

• 5+ years of experience in medical claims processing, billing, or revenue cycle management
• Knowledge of DME and complex rehab technology (CRT) billing, including Medicare, Medicaid, and commercial payer rules
• Experience with HCPCS coding, modifiers, and medical necessity documentation for CRT products
• Strong understanding of insurance verification, prior authorization, and appeal processes
• Proficiency in claims management systems and electronic billing platforms
• Excellent attention to detail, problem-solving, and organizational skills
• Certification in medical billing and coding (e.g., CPC, CPB, CRCS)
• Ability to analyze and resolve claim denials efficiently
• Strong written and verbal communication skills
• Capacity to work independently while collaborating with cross-functional teams
• Adaptability to changing payer policies and regulatory requirements

Responsibilities

• Be prepared to appeal or correct CRT claims in compliance with Medicare, Medicaid, and commercial insurance guidelines
• Ensure all required documentation (e.g., prescriptions, prior authorizations, therapist evaluations, and medical necessity justifications) is included with claims
• Verify coding accuracy, including HCPCS codes, modifiers, and pricing structures for CRT equipment
• Track and monitor outstanding claims, identifying and resolving denials or underpayments
• Communicate with Payer Team to address rejections, request re-considerations, and appeal denied claims as necessary
• Work closely with internal teams to obtain missing documentation or clarify coding and billing discrepancies
• Analyze claim’s files from CRT providers and effectively communicate trends or challenges to provider and internal teams
• Maintain up-to-date knowledge of payer policies, Medicare/Medicaid requirements, and regulatory changes affecting CRT reimbursement
• Ensure claims processing adheres to HIPAA regulations and payer-specific guidelines
• Document claim activity and payer communications in the claims management system
• Assist providers and patients with claim-related inquiries, explaining coverage and reimbursement status
• Join provider calls and give proper guidance around documentation and claims submission best practices to reduce denials

Preferred Qualifications

• Prior experience working for a CRT provider, DME supplier, or payer specializing in rehab technology
• Familiarity with payer portals and electronic remittance advice (ERA) processing

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities
• Remote Opportunities