Medical Claims Specialist - Remote

Overview

The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring compliance and enhancing client relationships.

• Maintain ongoing knowledge of program requirements
• Analyze and process claims for accuracy, eligibility, and benefits coverage
• Retain and strengthen relationships with clients and members
• Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
• Correspond to verify if the amounts are related to the claim
• Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
• Adhere to quality assurance objectives and goals
• Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising s returns from administration services
• Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
• Keep management updated on activities, issues and developments
• Document all claims decisions and communications with members in the system accurately and timely
• Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
• Special projects as assigned by management

Program Manager

• High school diploma required;
  Associate s or Bachelor s degree preferred
• CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred

• 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position

• Knowledge of Group Health Insurance, Workers  Compensation, No-Fault, and/or Liability industry
• Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices
• Well-developed time-management, organization, and prioritization skills
• Excellent analytical skills
• Customer-service orientation
• Excellent oral and written communication skills
• Knowledge of medical billing procedures
• Ability to gather data, compile information, and prepare summary reports
• Strong interpersonal and conflict resolutions skills
• Ability to work independently and as part of a team in a fast-paced, multi-faceted environment
• Demonstrated persistence and attention to detail

• Remaining in a seated position
• Entering text or data into a computer
• Visual Acuity
• Talking
• Hearing
• Repetitive arm, hand, and finger motions
• Working remotely some or all of the time

• Pay Range: $24-28.00
• Health insurance (4 different plans to choose from)
• Dental
• Vision
• Paid time off (PTO) or Flexible Time Off (FTO)
• 401(k)
• Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
• Voluntary Life Insurance and Short-Term Disability Insurance
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Rise Well Wellness Program
• Professional Development Reimbursement Program (PDRP)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work

Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations.

• Continuous technological improvement
• Entrepreneurial attitude
• Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what s really important, and keeping a sense of humor
• Responding quickly to client needs
• Being the best, not the biggest

• Associate

• Full-time

• Administrative
• Industries: IT Services and IT Consulting

Referral note:
Referrals increase your chances of interviewing at Rising Medical Solutions by 2x

MEDICAL ASSISTANT SR - FIXED, FCP - CARE COORDINATION