Healthcare Claims Denials Specialist

Humana Inc; South Carolina; Remote; USD 43,000 - 57,000; Full time

Job summary

Join a leading healthcare company as an RCM Healthcare Claims Denials Specialist. You will manage claims, ensure timely reimbursements, and support agency personnel in navigating the claims process. This role offers competitive benefits and a chance to make a significant impact in healthcare.

Benefits

Health benefits effective day 1

Paid time off

401(k) retirement savings plan with employer match

Tuition assistance

Career development opportunities

Qualifications

• Minimum of two years medical claims processing experience.
• Knowledge of healthcare collection procedures.

Responsibilities

• Ensure timely reimbursement of receivables.
• Research and resolve claims that have not passed payer edits.
• Guide agency personnel on claims processing.

Skills

Analytical Skills

Communication Skills

Education

High School Diploma

Tools

Microcomputer Software

Job description

Become a part of our caring community and help us put health first

As an RCM Healthcare Claims Denials Specialist/Accounts Receivable Specialist, you will:

• Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

• Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

• Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

• Clear payment variances, resolving differences, and initiating corrective action.

• Guide/instruct and support agency personnel encompassing all aspects of insurance and non-Medicare claims processing.

• Prepare input data forms to update computer system.

• Review and communicate with agencies to educate them about expectations for clean claims.

Use your skills to make an impact

Required Qualifications

• High School Diploma or the equivalent

• Minimum of two years medical claims processing experience

• Knowledge of healthcare collection procedures and microcomputer software/hardware

• Effective analytical and communication skills

Additional Information:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:

• Health benefits effective day 1

• Paid time off, holidays, and jury duty pay

• Recognition pay

• 401(k) retirement savings plan with employer match

• Tuition assistance

• Scholarships for eligible dependents

• Caregiver leave

• Employee charity matching program

• Network Resource Groups (NRGs)

• Career development opportunities

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$43,000 - $56,200 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.