Claims Resolution Specialist

Summary

Join Integra Partners as a Claims Resolution Specialist and review Durable Medical Equipment (DME) claims for accuracy, ensuring compliance with all regulations. You will maintain documentation, resolve issues timely, and contribute to a collaborative team environment. This role requires experience with medical billing, claims, and relevant software. Integra offers competitive compensation, including a bonus program, 401k matching, comprehensive health benefits, paid time off, and remote work opportunities. The position involves daily productivity goals, problem-solving, and staying updated on industry changes. Growth opportunities and professional development are also provided.

Requirements

• Familiarity with the 1500 claim forms, and DMEPOS services
• Knowledge of ICD-10, HCPCS, and medical terminology
• Understanding of CMS guidelines, and Medical Policy adopted by the plan
• Correctly read and assess medical documents
• Must type 45+ words per minute
• Computer experience, and the ability to learn new programs and software, Microsoft Word and Microsoft Excel background is a necessity
• Conduct yourself in a courteous, helpful, and professional manner at all times
• Passion for your work and the mission of the company
• Motivated and able to work independently within a fast-paced, team environment
• Must be organized and thorough
• Sound judgement and critical thinking
• Ability to work overtime as required
• Must follow policies regarding attendance and punctuality
• Meet all daily productivity and weekly quality goals

Responsibilities

• Accountable for daily productivity goals at or above the current production metric
• Maintain a climate of teamwork and collaborative problem solving
• Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectives
• Stay informed on product information, changes in Medicare/State/Contract funding procedures, and updates in policies and procedures
• Contribute beyond fundamental responsibilities to support company growth and department development
• Adds value and positive contributions towards the company and department culture
• Understand and perform duties in compliance with State and Federal regulations and the policies and procedures of Integra
• Achieve and maintain an individual effectiveness rate of 70% +
• Contributes to the department maintaining AR aging over 120 days at 10% or less of total inventory
• Strong Microsoft Office skills (Excel in particular) and ability to learn new programs and software
• Must type 45+ words per minute
• Familiar with ICD-10, HCPCS, and medical terminology
• Ability to follow verbal and written instructions
• Ability to maintain consistent, regular attendance and punctuality
• Performs miscellaneous duties as assigned

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