Claim Edit Specialist - Remote

Qualderm; United States; Hybrid; USD 27,000 - 38,000; Full time

Benefits offered by this job

Competitive Pay

Comprehensive Health Coverage

Generous 401(k) Plan

Paid Time Off (PTO)

Company-Paid Life Insurance

Disability Protection

Wellness Plans

Employee Assistance Program (EAP)

Exclusive Employee Discounts

Referral Bonus Program

Job summary

QualDerm Partners is seeking a Revenue Cycle Specialist to identify and resolve third-party payer rejections and assist in ensuring accurate charge submissions across our dermatology network. The role collaborates with the coding team to enter charges in the EMR and resolve edits that affect payments.

You will monitor missing charges, analyze trends, and escalate issues to RCM leadership while maintaining timely communication with multiple departments.

Qualifications

• 1-3 years of medical billing/RCM experience in a physician practice or billing company.
• Completion of Modernizing Medicine University courses within 6 months of hire.
• Excellent verbal and written communication and attention to detail.

Responsibilities

• Manage claims returned which have failed scrub rules
• Identify and resolve payer rejections in a timely manner
• Enter charges/bills into EMR in coordination with certified coding team/Coding manager
• Monitor missing charges and communicate with RCM management as needed
• Must have knowledge of claim correction, electronic claim submission
• Ability to contact payers when necessary to resolve any issues
• Report any trends in a timely manner to RCM leadership that prevent successful claim submission
• Ability to effectively communicate with other departments such as Coding, AR/Follow-up, Patient Services and Posting

Skills

Payer rejections resolution

EMR data entry

Attention to detail

Excel data analysis

Team collaboration

Tools

MS Excel

EMR system

Billing software

Modernizing Medicine University courses

Job description

With 150+ locations in 17 states, QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. At QualDerm Partners, we are united in our purpose: to educate, protect, and care for your skin. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you!

Our mission is to educate communities and healthcare professionals about the importance of skin health; including skin cancer prevention, risk factors and how to achieve healthy skin through annual skin exams and dermatologic care. We strive to provide the latest proven, proactive and comprehensive dermatologic care to populations in the expanding geographies we serve by making high-quality skin care timelier and more accessible all while creating a rewarding work environment for our providers and employees.

Purpose:

Responsible for identifying and resolving third-party payer rejections. Will assist in resolution of edits/ errors that may result in nonpayment of charges or prevent charges from being accepted by payers. Also responsible for entering bills/charges with input from certified coding team when necessary.

Essential Duties and Responsibilities:

• Manage claims returned which have failed scrub rules
• Identify and resolve payer rejections in a timely manner.
• Enter charges/bills into EMR in coordination with certified coding team/Coding manager
• Monitor missing charges and communicate with RCM management as needed
• Must have knowledge of claim correction, electronic claim submission
• Ability to contact payers when necessary to resolve any issues
• Report any trends in a timely manner to RCM leadership that prevent successful claim submission
• Ability to effectively communicate with other departments such as Coding, AR/Follow-up, Patient Services and Posting

• 1-3 years’ experience in a medical/insurance environment for physician practice or billing company
• Revenue cycle experience preferred
• Complete Modernizing Medicine University courses within 6 months of hire
• Strict attention to detail
• Ability to meet deadlines in a fast paced, start-up, results-oriented environment, as well as excellent organizational skills
• Excellent verbal and written communication skills
• Proficient Microsoft Office Suite products, specifically Excel and ability to analyze large data sets
• Ability to collaborate and work in a team environment

Benefits of joining Qualderm Partners:

• Competitive Pay – Attractive compensation to reward your hard work
• Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered
• Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting
• Paid Time Off (PTO) – Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year
• Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans
• Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances
• Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security
• Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges
• Exclusive Employee Discounts – Save on products and services with special discounts just for you
• Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team

QualDerm Partners is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Applicants must be currently authorized to work in the United States in a full-time basis.

Compensation Range:

$19.35 - $27.33 per hour. Final offer will be based on a combination of skills, experience, location, and internal equity.