Quality & Claims Specialist (Medical Billing)

Reliable Respiratory; Williston (VT); On-site; USD 42,000 - 64,000; Full time

Job summary

Reliable Respiratory is seeking a Quality Specialist to review patient charts and sales orders, ensuring accuracy and proper documentation for successful claim payment. You will collaborate with providers, payors, and the medical team to obtain current information and ensure compliance with authorization and billing requirements.

The role demands strong attention to detail, problem solving, and customer service in a fast-paced office setting.

Qualifications

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

Responsibilities

• Ensure patient charts are accurate and complete with necessary information.
• Ensure sales orders are accurate and complete with necessary information.
• Update patient insurance policies and adjust sales orders as needed.
• Obtain current patient information and medical documentation for timely processing of orders.
• Verify insurance eligibility by contacting payors to confirm terms and benefits.
• Perform basic billing tasks to ensure orders bill correctly.
• Explain payor coverage requirements and assist with appeals for denied services/claims.
• Escalate accounts not meeting insurance or provider guidelines.
• Stay updated on insurance guidelines and billing requirements.
• Participate in meetings and take on special projects as assigned.

Skills

Problem solving

Active listening

Decision making

Organizational skills

Customer service

Attention to detail

Teamwork

Independence

Communication

Time management

Education

Associate’s degree or 2 years relevant experience

Tools

Microsoft Office Suite

Job description

Reliable Respiratory is seeking a Quality Specialist to review patient charts and sales orders, ensuring accuracy and proper documentation for successful claim payment. You will collaborate with providers, payors, and the medical team to obtain current information and ensure compliance with authorization and billing requirements.

The role demands strong attention to detail, problem solving, and customer service in a fast-paced office setting.