Medical Billing & Claims Quality Specialist

Reliable Respiratory; Hartford (VT); On-site; USD 50,000 - 70,000; Full time

Job summary

Reliable Respiratory in the United States seeks a Quality Specialist to review patient charts and sales orders, ensuring information, documentation, prior authorization, and patient eligibility are met to support successful payment of claims and excellent patient service.

The role collaborates with payors, providers, and team members to verify insurance benefits, adjust orders, and maintain compliance with guidelines, delivering responsive support in a fast-paced office environment.

Qualifications

• Must be 18 years of age or older.
• Eligible to work in the United States without future sponsorship.
• Associate’s degree or 2 years of relevant (authorization, claims, quality or billing) experience.

Responsibilities

• Ensure patient charts are accurate and contain all required information.
• Ensure sales orders are accurate and complete.
• Update patient insurance policies and adjust sales orders as needed.
• Collect current patient information and medical documentation for timely processing of sales orders.
• Verify patients’ insurance eligibility by contacting payors and confirming benefits.
• Perform basic billing tasks to ensure correct charges and dates of service.
• Explain payor coverage requirements and assist with appeals for denied services/claims.
• Escalate accounts that do not meet guidelines or authorization requirements.
• Stay up to date on insurance guidelines and billing requirements.

Skills

Problem solving

Active listening

Decision making

Attention to detail

Communication

Customer service

Organization

Proactive work

Education

Associate’s degree or 2 years relevant experience

Tools

Microsoft Office Suite

Job description

Reliable Respiratory in the United States seeks a Quality Specialist to review patient charts and sales orders, ensuring information, documentation, prior authorization, and patient eligibility are met to support successful payment of claims and excellent patient service.

The role collaborates with payors, providers, and team members to verify insurance benefits, adjust orders, and maintain compliance with guidelines, delivering responsive support in a fast-paced office environment.