Revenue Cycle Claims Specialist

Azalea Health Innovations Inc; Valdosta (GA); Vor Ort; USD 42.000 - 64.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision insurance

Life insurance

Paid time off

Zusammenfassung

Azalea Health is seeking a Revenue Cycle Claims Specialist to manage the lifecycle of medical claims and ensure accurate, timely submission. You will work with clearinghouses, payers, and internal teams to reduce rejections and accelerate reimbursement, while maintaining HIPAA compliance and documenting claim activity.

The ideal candidate has 2+ years in progressive RCM billing and coding, CPC/CPB certification preferred, and strong analytical and customer service skills.

Qualifikationen

• Associates or Bachelors Degree preferred.
• CPC, CPB or equivalent highly preferred.
• Minimum 2 years' experience in progressive RCM billing and coding.
• Minimum of 1 year of customer service/client relations and employee training experience.
• Excellent computer skills with strong proficiency in web-based and SaaS applications.

Aufgaben

• Review and validate claims for accuracy, completeness, and compliance prior to submission.
• Ensure all required elements are present (coding, modifiers, authorizations).
• Submit claims through clearinghouses or payer portals in a timely manner.
• Maintain productivity benchmarks and KPI's for claim processing and submission.
• Review claim edits and scrubbing rules to identify errors before submission.
• Correct issues related to coding, modifiers, eligibility, or missing information.
• Monitor and resolve any clearinghouse edits and rejections; as well as payer rejection reports daily.
• Research and resolve rejected claims promptly to avoid delays in payment.
• Identify root causes of rejections and implement corrective actions.
• Track rejection trends and elevate systemic issues.
• Stay current on payer specific billing requirements, edits, and submission guidelines.
• Ensure all claims meet payer guidelines, regulatory requirements, and internal SOPs
• Maintain accurate documentation of claim activity and corrections.
• Identify recurring claim errors, rejection patterns, or workflow inefficiencies.
• Provide feedback to leadership and cross-functional teams to improve clean claim rates.
• Support onboarding of new clients or payers by ensuring proper claim setup and workflows.
• Effectively communicate directly with clients via tasks to help resolve claim related issues.
• Partner with internal teams to collaborate on resolving claim issues.
• Maintain HIPAA compliance when handling patient protected health information (PHI)

Kenntnisse

Attention to detail

Analytical thinking

Customer service

Proactive problem-solving

Ausbildung

Associates or Bachelor's Degree preferred

CPC, CPB or equivalent certification preferred

Tools

Clearinghouses

Payer portals

SaaS applications

Jobbeschreibung

IN SUMMARY...

The Revenue Cycle Claims Specialist is responsible for managing the lifecycle of claims to ensure accurate, timely submission and resolution. This role focuses on reviewing, validating, and resolving claim issues prior to and after submission, with an emphasis on reducing rejections, minimizing denials, and accelerating reimbursement.

The Claims Specialist works closely with clearinghouses, payers, and internal teams to identify and correct claim errors, monitor claim status, and ensure compliance with payer requirements and billing guidelines. This position requires strong attention to detail, analytical thinking, and a proactive approach to identifying and resolving barriers to clean claim submission and payment.

WHAT YOU WILL DO...

• Review and validate claims for accuracy, completeness, and compliance prior to submission.
• Ensure all required elements are present (coding, modifiers, authorizations).
• Submit claims through clearinghouses or payer portals in a timely manner.
• Maintain productivity benchmarks and KPI's for claim processing and submission.
• Review claim edits and scrubbing rules to identify errors before submission.
• Correct issues related to coding, modifiers, eligibility, or missing information.
• Monitor and resolve any clearinghouse edits and rejections; as well as payer rejection reports daily.
• Research and resolve rejected claims promptly to avoid delays in payment.
• Identify root causes of rejections and implement corrective actions.
• Track rejection trends and elevate systemic issues.
• Stay current on payer specific billing requirements, edits, and submission guidelines.
• Ensure all claims meet payer guidelines, regulatory requirements, and internal SOPs
• Maintain accurate documentation of claim activity and corrections.
• Identify recurring claim errors, rejection patterns, or workflow inefficiencies.
• Provide feedback to leadership and cross-functional teams to improve clean claim rates.
• Support onboarding of new clients or payers by ensuring proper claim setup and workflows.
• Effectively communicate directly with clients via tasks to help resolve claim related issues.
• Partner with internal teams to collaborate on resolving claim issues.

• Maintain HIPAA compliance when handling patient protected health information (PHI)

BACKGROUND AND SKILLS YOU WILL BRING...

• Associates or Bachelors Degree preferred
• CPC, CPB, or equivalent highly preferred
• Minimum 2 years' experience in progressive RCM billing and coding
• Minimum of 1 year of customer service/client relations and employee training experience
• Excellent computer skills with strong proficiency in web-based and SaaS applications

SUCCESS LOOKS LIKE...

• Being aggressive and taking initiative; we trust you to move the needle forward
• Doing the job; outcomes are just as important as strategy
• Being adaptable and amenable to meet the changes of a dynamic and evolving industry
• Demonstrating humility; partnership and collaboration is who we are and how we operate
• Tapping into your innovative side; conventional is not always correct

HOW WE INVEST IN YOU...

• Competitive and comprehensive benefits: Coverage options to support the whole person, including full medical, dental, vision, and life insurance
  • Generous employer sponsored subsidy towards employee's medical insurance premiums
  • Azalea Health covers 100% of the premiums for Life AD&D and Long-Term Disability for all eligible full-time employees
• Balance and flexibility: Simple Paid Time Off (PTO) options. You earn your time, use it as you choose.
• Economic opportunity: Competitive total rewards package that offers competitive pay and advancement opportunities

Azalea Health's EEO Statement

Azalea Health is an Equal Opportunity Employer committed to creating a diverse and inclusive workforce where our employees excel based on merit, qualifications, knowledge, ability, and job performance. We embrace and encourage our employees' differences in age, color, disability, ethnicity, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socioeconomic status, veteran status, and any other characteristics protected by federal, state, and local laws that make our employees unique.