CRT Claims Examiner

Summary

Join Integra as a Claims Examiner and provide real-time support to complex rehab technology (CRT) providers, helping them navigate billing complexities with payers and internal teams. Collaborate with multiple entities to solve challenges, demonstrating problem-solving and process management skills. The ideal candidate will drive results through teamwork, exhibiting high energy and passion for healthcare. This role involves appealing or correcting CRT claims, ensuring accurate documentation, verifying coding, tracking outstanding claims, and communicating with payers. Maintain knowledge of payer policies and regulations, and assist providers and patients with claim-related inquiries. The position offers competitive compensation and a comprehensive benefits package.

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