Claims Submission Specialist (Claim Processor)

Job Summary: Under the direction of the Claims Submission Specialist Team Lead, the claims submission specialist will submit accurate and clean claims in a timely manner to the payers for all assigned accounts. The claims submission specialist will also submit required attachments for all claims requiring them through Waystar all assigned accounts. This position is fully remote from the following states: AL, AZ, FL, GA, KY, MI, MS, SC, TN, TX, UT, VA, WA, WY Flexible hours. Create your own daily 8 hour work days. Must be within operating hours of 7am to 7pm EST. About Revenue Cycle Solutions, LLC (RCS): RCS is a leading provider of revenue cycle management solutions for healthcare organizations. We are committed to delivering exceptional service and innovative solutions that help our clients optimize their revenue cycle processes, improve financial performance, and enhance patient satisfaction. We value our employees and strive to create a positive and supportive work environment where everyone can thrive.

Our Mission

Statement:

• Collect as much as client structure allows
• Collect as quickly as possible
• Complete numbers 1 and 2 as efficiently as possible
• **RCS does not offer health insurance benefits

Responsibilities:

• Educate and promote RCS’s 3 objectives
• Attend scheduled cadence calls with Team Lead (weekly, bi-weekly, monthly, or quarterly) to review barriers to submitting clean claims (client, payer, clearinghouse, etc.)
• Work together as a team to resolve those issues
• Import claims from EMR to billing software (if applicable)
• Verify all information contained on each claim is correct: Referring provider, Patient DOB, Spelling of names, Subscriber name and DOB if applicable, Correct payer(s), Correct member ID(s), Add/Correct authorization number (if necessary), DOI (if WC or Auto), Accident state (if Auto), DX Codes, Modifiers, All CPT codes have $ amounts, Rendering provider, Rendering location (for clients with multiple), Tax ID # (for clients with multiple)
• Submit claims
• Check Waystar for 997 Acknowledgment Report
• Print paper claims as needed: Attach medical records to paper claims as necessary, Mail or fax claims as required
• Communicate claim issues with Team Lead
• Complete claim attachments through Waystar
• Complete audits in a timely manner
• Manage credentialing holds
• CCI quarterly updates
• Notify Team Lead of software rule updates
• Identify electronic claim submission opportunities - communicate to Team Lead to add payer ID to software platform
• Identify/Rectify name matching rejections in Waystar
• Log PDS daily and accurately
• Other duties as assigned

Expectations:

• Maintain Employee/Management/Client Confidentiality
• Promote and maintain Team Vitality within and between teams
• Become proficient in all assigned platforms used by RCS as pertains to role
• Provide clear and concise communication

Requirement

• Claim processing: 1 year (Required)
• Physical Therapy: 1 years (Peferred)
• Authorized to work in the United States (Required)
• Must reside in one of the states listed: AL, AZ, FL, GA, KY, MI, MS, SC, TN, TX, UT, VA, WA, WY (Required)
• Current or most recent role must be a Claims Submission Specialist/Claim Processor or similar (Required)

Benefits:

• PTO
• 401K
• Paid Holidays
• Paid Sick Time
• Office Equipment Reimbursement
• Flexible Work Hours
• Remote Work From Home
• ZayZoon

Join our team as a Claims Submission Specialist where your expertise will contribute significantly to enhancing client satisfaction and ensuring seamless operations within our organization. Job Type: Full-time Pay: $16.00 - $19.00 per hour Benefits:

• Flexible schedule
• Paid time off
• Work from home

Application Question(s):

• What state do you live in? (Note: To be eligible, residency must be in one of the following states: AL, AZ, FL, GA, KY, MI, MS, SC, TN, TX, UT, VA, WA, or WY)?
• What is your email address?
• What is your current or last employment title? (Note: A Claim Processor or similair must be your current or most recent role to qualify.)
• Are you a U.S. Citizen? (Note: Proof of citizenship, such as a U.S. Passport or U.S. Birth Certificate, is required for this role.)

Experience:

• Claim processing/submission: 1 year (Required)
• Data entry: 1 year (Required)
• Physical therapy: 1 year (Preferred)

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