Job Description (Claims Specialist)
Location – Hybrid (NCR)
About Sciometrix
At Sciometrix, our goal is to deliver the best-ever personalized care with utmost compassion enabling patients to lead healthier and happier lives. Our commitment to innovation in healthcare technology drives us to lead the way in Care Management, Digital Care Coordination, Value-Based Care, and Population Health.
“We envision a world where advanced technology and human compassion intersect seamlessly to deliver superior patient experiences and outcomes.”
Our mission is to enhance the lives of patients by leveraging digital solutions that reduce hospital readmissions, improve health outcomes, and optimize the delivery of healthcare services.
At the heart of our philosophy lies the belief that every patient deserves access to the highest quality of care, tailored to their individual needs. We strive to make this vision a reality by pioneering innovative solutions that prioritize patient well-being and provider efficiency.
With Sciometrix, the future of healthcare is not just about treating illnesses; it's about empowering patients to live their best lives.
What's in it for you? 🚀
- Thriving in Telehealth Innovation: Join the forefront of digital healthcare with Sciometrix, where you'll contribute to cutting-edge technology in telehealth and virtual care management.
- Impactful Patient Engagement: Be part of a mission to engage patients and deliver better outcomes, enhancing their healthcare experiences through advanced technology and human expertise.
- Professional Growth: Sharpen your skills and expand your knowledge in accounts receivable (AR) management and denial resolution within the US healthcare industry, building on your existing 4 years of experience.
- Autonomous Work Environment: Enjoy the autonomy to work independently, leveraging your expertise in AR calling and denial management to resolve patient accounts effectively.
- Collaborative Culture: Engage in effective communication and coordination with the finance team, contributing to accurate payment processing and billing-related concerns resolution.
- Continuous Learning: Stay updated with evolving insurance guidelines, requirements, and changes, enhancing your understanding of revenue cycle management and insurance denials.
- Tech-Savvy Environment: Utilize your knowledge of different EMR platforms and healthcare billing software, including AdvancedMD and Waystar billing platforms, to streamline processes and ensure compliance.
- Flexible Schedule: Benefit from flexible work hours, allowing you to maintain a healthy work-life balance while delivering excellence in AR capabilities.
- Comprehensive Benefits Package: Access comprehensive insurance benefits, annual performance bonuses, and reimbursements, ensuring your well-being and satisfaction within the organization.
We're seeking an Claims Specialist with 4+ years of US healthcare industry experience in AR calling and denial management. You should excel in written and verbal communication, work autonomously, and possess a strong grasp of Revenue Cycle Management and insurance denials. Proficiency in EMR platforms like EPIC, AdvancedMD, and knowledge of medical billing procedures and codes are crucial. Experience in Telehealth processes, especially RPM and CCM, is preferred. If you're detail-oriented, proactive, and passionate about enhancing patient care through technology, we invite you to apply.
Job Responsibilities
- Review and verify Patient balance to provide resolution on open AR patient accounts.
- Investigate and resolve Denial/rejection discrepancies in insurance claims.
- Ensure timely follow-up with Insurance on the claims pending for payments via call/websites to insurance carriers to obtain and take appropriate actions to resolve the claims in timely manner.
- Research and understand insurance guidelines, requirements, and changes related to resolve the Account balance stuck in patient accounts.
- Reconcile accounts receivable to ensure accurate and up-to-date financial records.
- Communicate and coordinate effectively with the finance team to accurately process payments and handle any billing-related concerns.
- Provide inputs and share best practice to improve the AR capabilities.
- Ability to perform patient eligibility.
Requirements
- Should be working as an Claims Specialist with proven minimum 4 years of experience in AR calling and denial management in US healthcare industry.
- Excellent written and verbal communication skill.
- Should be able to work independently without any supervision.
- Good knowledge of Revenue Cycle Management and insurance denials.
- Good understanding on different EMR platforms (EPIC, AdvancedMD, ECW,
Practice fusion etc).
- Familiarity with healthcare billing software and systems, especially AdvancedMD and Way star billing platforms.
- In-depth knowledge of medical billing procedures, codes, and regulations, including knowledge of CPT, ICD-10, and HCPCS code
- Knowledge of Telehealth – RPM and CCM process is highly preferred.
Benefits
- Comprehensive Insurance benefits
- Flexible work hours
- Annual Performance Bonus
- Reimbursements
- Skills: mobile applications,frontend development,react native,flutter
- make a whats in it for you section with emojis for this role
Skills: eligibility,healthcare,telehealth,denials,ar system
