Insurance Specialist 3 – Long Term Care Biller

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🕒 Julho 6

🌺 Hawaii – Remoto

🌺 Hawaii – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🔒 Seguros

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CorroHealth

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth é um provedor líder de análises de saúde clinicamente orientadas e soluções impulsionadas por tecnologia, focado em melhorar o desempenho financeiro de hospitais e sistemas de saúde. Suas soluções integradas e tecnologias avançadas visam otimizar todo o ciclo de receita, oferecendo serviços como gestão do ciclo de receita, documentação clínica, codificação médica e gestão de recusas. Com um compromisso de melhorar a saúde financeira por meio de tecnologia inteligente e orientação especializada, a CorroHealth aborda complexas relações entre pagadores e prestadores e apoia operações de saúde eficientes.

Descrição

• Resolving complex, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF) or intermediate care facility (ICF) claims. • Preparing and submitting claims to Medicare, Medicaid, and private insurers; ensuring compliance with federal and state billing regulations (including UB-04 and RAI/MDS requirements); • Verifying coverage and eligibility; and resolving claim denials or discrepancies. • Coordinating with clinical, admissions, and finance teams to ensure accurate documentation, maintaining patient billing records, and optimizing reimbursement through proper coding and timely claim submission. • Possessing knowledge of LTC billing systems, reimbursement models, and payer guidelines is essential. • Identifying and reporting trends found during the account resolution process such as CPT/HCPCS errors/deletions, duplicate claims, revenue code mapping mismatches, missing charges, no claim on file. • Performing financial account assessment functions including but not limited to adjustments and determining balance to patient. • Working within client systems to complete rebill functions. • Performing administrative functions including but not limited to medical record submissions, billing claims, patient assistance outreach, obtaining documents from client systems and insurance plan code updates, review corrected claim requests and approve for client assistance or correct the bill within client platform, review and submit payment verification assistance requests. • Maintain familiarity with client preferences and known issues across multiple client accounts. • Support special projects for clients as needed. • Other duties as assigned.

🎯 Requisitos

• High School Diploma or equivalent • 5+ years relevant industry experience in registration, billing, collections, required • 3+ years' experience with LTC and/or SNF claims resolution, required • Knowledge of UB04 claim forms, EOB’s and medical records required • ICD-9, ICD-10, CPT and HCPCS coding knowledge required • Ability to conduct detailed research to resolve complex claims • Intermediate mathematics skills (addition, subtraction, ability to identify trends, etc.) • Ability to compile and summarize data • Strong verbal and written communication skills • Ability to analyze and interpret complex documents, contracts, notes, and other correspondence • Ability to prioritize and multitask in a fast-paced environment • Ability to work effectively in a remote environment • Investigative mind set to identify issues and implement solutions.

🏖️ Benefícios

• Medical/Dental/Vision Insurance • Equipment provided • 401k program • Accrued PTO - 80 hours annually • Paid Paternity & Maternity leave programs • 9 paid annual holidays • Tuition reimbursement • Professional growth and much more!