(Contract) Medical Claims Resolution Specialist

We hold ourselves to exceptionally high standards in order to provide unparalleled service to healthcare professionals, their staff and patients. We strive to end each workday knowing that we’ve made someone’s life better.Our team is comprised of courageous and caring healthcare warriors. We’re here to solve the impossible problems, such as reducing medical errors, saving patient lives, and empowering physicians to stay financially independent. We care deeply about making a big impact and we are relentless.Inspired to grow the company and our careers, we remain committed to daily discipline, self improvement, and a ceaseless search for solutions.We equally value our work and our life apart from work. We’re compelled to work with urgency, decisiveness, and efficiency in everything we do. This affords us freedom and time for things that matter most. Leaders at pMD are developed through our mentorship program. Investing in the success of each individual strengthens our team and builds loyalty. We believe in leading by example. Everything one does ripples outward. Therefore, we need each individual at pMD to embody our core values to thrive as an enduring great company.

(Contract) Medical Claims Resolution Specialist

The (Contract) Medical Claims Resolution Specialist role at pMD helps our physician practices maximize revenue through aggressive follow up on healthcare insurance receivables. This role will help our team gain valuable information to aid in the resolution of outstanding claims and support prompt payment.

Responsibilities include:

• contact insurance carriers to inquire about the status of past due accounts to secure payment of claims
• conduct research to update status of unpaid or denied claims
• take the necessary corrective action to resolve outstanding claims, including high-complexity charges, ensuring accuracy, timeliness, and compliance with payer guidelines in multistate practices
• prepare and submit claim appeals with supporting documentation to dispute denials
• document details of activity on each account in software solution program
• meet or exceed defined productivity standards (expected to follow up on 7 encounters per hour, 175 per week)
• demonstrate the highest level of compliance with all laws and regulations, including but not limited to HIPAA

Requirements include:

• make phone calls to insurance carriers between the operating hours of 8 am and 6 pm EST
• available to work a minimum of 20 hours per week to meet weekly goals
• have an active subscription to Microsoft Word and access to a reliable printer with sufficient supplies, such as paper and ink/toner
• knowledge of basic computer and word processing applications
• exceptional attention to detail
• demonstrated experience communicating effectively with payers
• prior collections or medical billing experience with a comprehensive understanding of ICD-10, HCPCS, and medical terminology
• w9 required - must currently work as a sole proprietor or have or be willing to register a business per independent contractor guidelines
• reside in the U.S.

Rate: $6.00 per claim. This role is paid on a per-verified claim basis.We are only accepting applications through our online job portal, Lever. We aren't able to consider and respond to other types of applications, including those sent via email to pMD support, at this time. Please direct application status questions to [email protected]. Candidates must be authorized to work in the U.S. and perform duties while physically located in the U.S. as a precondition of employment.

Originally posted on Himalayas

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