Claims Resolution Specialist

JOB OVERVIEWOur Claims Resolution Specialist role is responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy while maintaining appropriate documentation and account records, as well as timely issue resolution. In this role, you will ensure work is in compliance with all legal, regulatory, and internal Integra policies and procedures, including HIPAA compliance. If you have previous medical billing or claims experience, this role may be of interest as a next step in your career. JOB RESPONSIBILITIESAccountable for daily productivity goals at or above the current production metricMaintain a climate of teamwork and collaborative problem solvingUses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectivesStay informed on product information, changes in Medicare/State/Contract funding procedures, and updates in policies and proceduresContribute beyond fundamental responsibilities to support company growth and department developmentAdds value and positive contributions towards the company and department cultureUnderstand and perform duties in compliance with State and Federal regulations and the policies and procedures of IntegraAchieve and maintain an individual effectiveness rate of 70% +Contributes to the department maintaining AR aging over 120 days at 10% or less of total inventoryStrong Microsoft Office skills (Excel in particular) and ability to learn new programs and softwareMust type 45+ words per minuteFamiliar with ICD-10, HCPCS, and medical terminologyAbility to follow verbal and written instructionsAbility to maintain consistent, regular attendance and punctualityPerforms miscellaneous duties as assignedWHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?In the first 6 months you will learn Integra's claims platform (QUE) and how to navigate it thoroughly (i.e. transmit new claims to payers, submit corrected claims, update member information, adjust off correctly adjudicated claims, etc.).You will learn your job role and responsibilities and which tools/references are available to you to assist in resolving unpaid claims.You will build your knowledge base in relation to the insurance plans one plan at a time, so that in 6 months you are the subject matter expert on those plans and are able to spot any payer issue trends.During this time you will set measurable goals for personal development and growth.WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?You will be fully integrated with your job, company and team.You will continue to learn additional insurance plans and become a subject matter expert on multiple plans.You will contribute your skills and knowledge to meet your department's metrics and goals.You will have regular monthly one-on-one meetings with leaders for mutual feedback and have initiated your personal development plan so you have started to define a path for growth.COMPENSATION: $19.00/hourEXPERIENCE:Familiarity with the 1500 claim forms, and DMEPOS servicesKnowledge of ICD-10, HCPCS, and medical terminologyUnderstanding of CMS guidelines, and Medical Policy adopted by the planCorrectly read and assess medical documentsMust type 45+ words per minuteComputer experience, and the ability to learn new programs and software, Microsoft Word and Microsoft Excel background is a necessityConduct yourself in a courteous, helpful, and professional manner at all timesPassion for your work and the mission of the companyMotivated and able to work independently within a fast-paced, team environmentMust be organized and thoroughSound judgement and critical thinkingAbility to work overtime as requiredMust follow policies regarding attendance and punctualityMeet all daily productivity and weekly quality goalsBenefits Offered Competitive compensation and annual bonus program 401(k) retirement program with company match Company-paid life insurance Company-paid short term disability coverage (location restrictions may apply) Medical, Vision, and Dental benefits Paid Time Off (PTO) Paid Parental Leave Sick Time Paid company holidays and floating holidays Quarterly company-sponsored events Health and wellness programs Career development opportunities Remote Opportunities We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington. Our Story Founded in 2005, Integra Partners is a leading network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We are reimagining access to in-home healthcare to improve the quality of life for the communities we serve. With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We're looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you. Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don't hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.Powered by JazzHR

Created: 2025-02-19