<p>Our client, an established organization in the Galleria area of Houston, TX, is seeking a seasoned Claims & Payment Processing Manager to lead a high-performing team in a fast-paced, high-risk environment. This is a fantastic opportunity for an innovative leader with a background in claims and payment processing within the insurance or healthcare industries.</p><p><br></p><p>Key Responsibilities:</p><p><br></p><p>Lead and manage a team responsible for end-to-end claims and payment processing, focusing on accuracy, timeliness, and compliance.</p><p>Monitor, analyze, and improve Key Performance Indicators (KPIs) to ensure team and process effectiveness.</p><p>Apply data-driven insights to enhance performance and streamline operations.</p><p>Champion technology-driven automation initiatives to improve efficiency.</p><p>Coach, mentor, and develop team members, fostering independent thinking and encouraging problem-solving.</p><p>Maintain strict confidentiality and uphold company and industry standards.</p><p>Proactively identify risks and implement solutions in a high-risk environment.</p><p><br></p><p>This is a direct hire role paying up to 120K plus benefits and bonus working 100% on-site.</p>
We are looking for a skilled and detail-oriented individual with experience in Medical Billing, Claims, and Collections to join our team in Daytona Beach, Florida. This role focuses on managing accounts receivable and collections for commercial insurance and Medicare/Medicaid accounts while ensuring compliance and accuracy in claims processing. As a long-term contract position, it offers the opportunity to contribute to vital healthcare operations within a dynamic environment.<br><br>Responsibilities:<br>• Handle accounts receivable clean-up activities, prioritizing outstanding commercial and Medicare/Medicaid balances.<br>• Oversee collection efforts by following up on aged accounts and resolving discrepancies to ensure timely payments.<br>• Review and process claims with a focus on accuracy, compliance, and timely reimbursement.<br>• Utilize Epic system work queues to verify that claims are complete, clean, and ready for submission.<br>• Collaborate with internal teams to support efficient billing operations and resolve AR-related challenges.<br>• Identify recurring issues in claims or AR processes and recommend improvements.<br>• Maintain accurate and up-to-date documentation across systems to ensure seamless operations.<br>• Provide expertise in navigating both legacy and updated systems for efficient claims and collections handling.<br>• Communicate effectively with payers to address disputes and secure resolutions for outstanding balances.
<p>We are looking for a dedicated Medical Billing Specialist to join our team. In this long-term contract position, you will play a vital role in ensuring the accuracy and efficiency of medical billing and claims processes, contributing to the financial health of our organization. This opportunity is ideal for professionals with a strong background in billing and coding who thrive in detail-oriented environments. This is a <strong>part-time</strong> opportunity only. </p><p><br></p><p>Responsibilities:</p><p>• Process medical claims with precision, ensuring compliance with billing regulations and payer guidelines.</p><p>• Verify patient insurance coverage and eligibility to facilitate proper claim submissions.</p><p>• Investigate and resolve discrepancies in billing and payment processes, maintaining accurate records.</p><p>• Collaborate with healthcare providers and insurance companies to address denied claims and secure reimbursements.</p><p>• Utilize medical coding systems and software to categorize procedures and diagnoses.</p><p>• Manage collections by following up on outstanding payments and negotiating resolutions.</p><p>• Monitor and update billing systems to reflect current codes and policies.</p><p>• Generate detailed billing reports to support financial analysis and decision-making.</p><p>• Maintain strict confidentiality of patient and financial information while adhering to HIPAA regulations.</p>
<p>We are looking for a dedicated Revenue Cycle Analyst to join our team near Oak Brook, Illinois, on a contract-to-permanent basis. This role is critical in ensuring the accuracy and compliance of revenue operations within a healthcare setting. The ideal candidate will play a key part in optimizing financial processes, supporting charge capture, and collaborating across departments to enhance operational efficiency and transparency.</p><p><br></p><p>Responsibilities:</p><p>• Ensure daily revenue integrity activities, including accurate and compliant charge capture processes.</p><p>• Research and design training programs to educate staff on best practices for revenue integrity.</p><p>• Conduct detailed reviews of revenue processes, presenting findings and recommending actionable improvements to leadership.</p><p>• Collaborate with Charge Description Master teams to maintain and update charge master systems.</p><p>• Develop performance reports and analytics to monitor charge capture activities and departmental compliance.</p><p>• Stay informed on regulatory changes affecting reimbursement and adjust revenue integrity strategies accordingly.</p><p>• Partner with departments such as Supply Chain, Clinical Operations, and Finance to enhance charge capture and revenue recognition.</p><p>• Provide insights and recommendations for strategic pricing and reimbursement initiatives based on thorough data analysis.</p><p>• Maintain dashboards to track revenue integrity efforts, compliance trends, and financial performance.</p><p>• Act as a subject matter expert to support staff in navigating operational and financial challenges related to revenue processes.</p>
<p>We are looking for a dedicated Personal Injury Claims Representative to join our team in the Lawrenceville, New Jersey area. In this role, you will manage complex personal injury protection claims, ensuring compliance with company policies and regulatory requirements. This position requires a detail-oriented individual with strong analytical skills and a commitment to delivering high-quality service.</p><p><br></p><p>Salary is 58,240 - 76,960.</p><p><br></p><p>Benefits include medical, dental, vision insurance, PTO, life insurance, and 401k. </p><p><br></p><p>Responsibilities:</p><p>• Investigate assigned claims, confirm coverage, verify eligibility, and determine the appropriate course of action.</p><p>• Evaluate gathered information to assess claim validity, injury extent, and potential exposure.</p><p>• Establish and maintain accurate reserves for each claim based on exposure estimates.</p><p>• Coordinate medical case reviews, independent medical examinations, or expert consultations when necessary.</p><p>• Respond to inquiries and concerns from subscribers, claimants, attorneys, and healthcare providers.</p><p>• Document claim files comprehensively and maintain an organized follow-up system for timely reporting.</p><p>• Ensure claims are managed in alignment with the organization's Decision Point Review Plan.</p><p>• Collaborate with internal departments and external specialists to optimize claim outcomes.</p><p>• Oversee loss adjustment expenses and manage vendor activities to ensure efficient and necessary work completion.</p><p>• Adhere to guidelines outlined in the Unfair Claim Practices Acts and other relevant regulations.</p>
<p>We are looking for an experienced Patient Accounts Representative / Biller to join our team <strong>fully on-site in Valhalla, New York</strong>. This <strong>long-term contract-to-hire</strong> opportunity offers an opportunity to play a key role in ensuring accurate and efficient revenue cycle operations within a healthcare setting. The ideal candidate will bring expertise in medical billing, claims processing, and collections while managing multiple priorities in a fast-paced environment.</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Perform full revenue cycle duties, including claim preparation, submission, reconciliation of AR accounts, and resolution of credit balances.</li><li>Responsible for the <strong>full billing cycle</strong>, including cash posting, collections, claim processing, and follow‑up.</li><li>Track progress of claims and reconcile payments to ensure accuracy.</li><li>Pursue denied claims, complete resubmissions, write appeal letters, and conduct phone/portal follow‑up with payers.</li><li>Review aging trial balances and work diligently to reduce AR balances.</li><li>Process claims for <strong>Medicaid FFS</strong>, Managed Care, commercial payers, and no‑fault insurance.</li><li>Work closely with the <strong>Patient Access Department</strong> to ensure clean claims and proper documentation.</li><li>Communicate effectively with individuals across varying knowledge levels.</li><li>Manage multiple priorities simultaneously while meeting strict deadlines.</li></ul><p><br></p>
We are looking for an experienced Medical Billing Specialist to join our team in Rochester, New York. In this Contract to permanent position, you will manage essential billing operations, ensuring accuracy and compliance within the healthcare industry. Your expertise in medical billing systems and software will be critical in supporting the financial operations of our organization.<br><br>Responsibilities:<br>• Process and manage medical claims with precision, ensuring compliance with healthcare regulations.<br>• Utilize accounting software systems to maintain accurate billing records and financial data.<br>• Handle accounts receivable tasks, including tracking payments and resolving discrepancies.<br>• Oversee appeals and claims administration to address denied or delayed claims effectively.<br>• Perform collection activities to recover outstanding balances while maintaining professionalism.<br>• Operate within EHR systems and tools such as Epic and Medisoft to streamline billing functions.<br>• Generate detailed financial reports using Microsoft Excel to support organizational decision-making.<br>• Collaborate with internal teams to optimize billing workflows and improve efficiency.<br>• Maintain up-to-date knowledge of healthcare billing codes and insurance policies.<br>• Support the integration and use of IBM AS/400 and other relevant systems for billing processes.
We are looking for a detail-oriented Automotive Claims Representative to join our team in Rockville Centre, New York. In this role, you will handle a variety of accounting tasks and ensure that claims are processed efficiently and accurately. The ideal candidate thrives in a structured environment and has a solid understanding of accounts payable, accounts receivable, and invoice processing.<br><br>Responsibilities:<br>• Process and manage automotive claims with accuracy and attention to detail.<br>• Handle accounts payable and accounts receivable transactions in a timely manner.<br>• Use QuickBooks to maintain and update financial records.<br>• Review and process invoices to ensure proper documentation and compliance.<br>• Enter data efficiently into accounting systems while maintaining accuracy.<br>• Communicate with clients and vendors to address inquiries and resolve discrepancies.<br>• Assist in reconciling accounts to ensure balanced financial records.<br>• Support the team in preparing reports and documentation as required.<br>• Monitor deadlines and prioritize tasks to meet organizational goals.
We are looking for a skilled Business Systems Analyst to join our team in Westlake, Ohio. This role is ideal for someone who thrives on analyzing complex data, translating business needs into actionable solutions, and collaborating across teams to enhance system functionality. The successful candidate will bring expertise in business analysis and a proactive approach to ensuring seamless project execution and client satisfaction.<br><br>Responsibilities:<br>• Analyze and interpret data files to translate between proprietary and standard formats, ensuring efficient resolution of business challenges.<br>• Document and implement functional requirements, technical specifications, and templates tailored to client needs while leveraging deep product knowledge.<br>• Review complex data sets, create mapping documents, and provide guidance on best practices to meet client requirements.<br>• Utilize internal databases to identify coding issues and recommend necessary adjustments.<br>• Act as a liaison between teams, managing system enhancements, defect resolution, and validation processes in collaboration with QA teams.<br>• Build and maintain strong relationships with clients, including executive-level stakeholders, and effectively communicate technical and non-technical concepts.<br>• Collaborate with IT teams to develop or improve client products, ensuring business requirements are met, conducting validations, and delivering end-user documentation and training.<br>• Identify opportunities for system improvements and escalate issues to ensure timely resolutions.<br>• Lead discussions with clients to understand their needs and provide strategic guidance, demonstrating professionalism and technical expertise.<br>• Participate in Agile-focused daily stand-up meetings and contribute to project success through disciplined adherence to the Software Development Lifecycle.
We are looking for a dedicated Medical Claims Specialist to join our healthcare team in Federal Way, Washington. This long-term contract position involves working to resolve medical claims efficiently while ensuring compliance with insurance policies and regulations. The role requires strong analytical skills and attention to detail to address complex issues and maintain high productivity standards.<br><br>Responsibilities:<br>• Conduct detailed benefit verification for patient insurance coverage to ensure accurate claims submission.<br>• Investigate and resolve unpaid or denied claims by analyzing root causes and utilizing available resources.<br>• Communicate effectively with insurance payers to address claim issues and facilitate timely payment.<br>• Interpret insurance contracts and regulations, ensuring compliance with state and employer-specific requirements.<br>• Participate in virtual meetings promptly, adhering to meticulous standards and security protocols.<br>• Utilize secure systems to manage sensitive data in a remote environment.<br>• Verify insurance authorizations and approvals accurately to support seamless claim processing.<br>• Collaborate with team members to resolve complex payment barriers and ensure smooth operations.<br>• Manage and resolve a set number of complex accounts daily, meeting productivity expectations.<br>• Respond promptly to supervisor and leadership inquiries during work hours, maintaining a high level of accountability.
<p>A Medical Center in Los Angeles is looking for a dedicated Surgery Medical Biller/Collections Specialist. This Surgery Medical Biller/Collections Specialist involves managing claim submissions, addressing denials, and ensuring the accuracy of billing processes to optimize reimbursement. The ideal candidate will bring expertise in medical billing, collections, denial management, and appeals, as well as familiarity with Epic billing workflows. </p><p><br></p><p>Responsibilities:</p><p>• Address and correct front-end edits and clearinghouse errors to facilitate clean claim processing.</p><p>• AR Insurance follow up via phone and online web portals. </p><p>• Submit electronic claims in compliance with specific payer guidelines and requirements.</p><p>• Manage timely corrections, rebills, and resubmissions of claims to resolve outstanding issues.</p><p>• Handle claim attachments and supporting documentation to meet payer requirements.</p><p>• Investigate and resolve denials by preparing appeals with appropriate clinical, coding, and billing documentation.</p><p>• Coordinate outreach to payers for unresolved or aged claims and follow up on outstanding accounts.</p><p>• Collaborate with patient access and coding teams to address discrepancies and ensure billing accuracy.</p><p>• Monitor payer trends, escalate systemic issues, and recommend improvements to prevent recurring denials.</p><p>• Verify patient information, including demographics, insurance coverage, and authorization details, to ensure claims are accurate before submission.</p><p>• Assist leadership with high-dollar or time-sensitive accounts to ensure timely resolution.</p>
<p>We are looking for a dedicated Medical Billing Specialist. In this Contract to permanent position, you will play a vital role in ensuring accurate and efficient processing of medical claims, helping the organization maintain compliance and achieve timely reimbursements. This role requires a keen eye for detail and a strong understanding of medical billing processes and terminology.</p><p><br></p><p>Responsibilities:</p><p>• Prepare and submit accurate medical claims to insurance providers for reimbursement.</p><p>• Verify patient information, including demographics and insurance details, to ensure claims are processed correctly.</p><p>• Review denied or unpaid claims, identify issues, and submit appeals to resolve discrepancies.</p><p>• Communicate effectively with insurance companies, patients, attorneys, and healthcare providers to address billing inquiries.</p><p>• Maintain compliance with patient confidentiality regulations and organizational standards.</p><p>• Monitor and manage accounts receivable, ensuring timely follow-up on outstanding balances.</p><p>• Collaborate with team members to improve billing procedures and enhance operational efficiency.</p><p>• Maintain accurate records of billing activities and updates within electronic medical systems.</p>
<p>We are looking for a skilled Revenue Integrity Analyst to join our team on a contract basis in Jacksonville, Florida. This role involves working closely with healthcare revenue cycle processes to ensure accurate medical billing and claims management. If you have experience in healthcare revenue cycles and a strong understanding of billing functions, we encourage you to apply.</p><p><br></p><p>Responsibilities:</p><p>• Oversee and analyze healthcare revenue cycle processes to optimize efficiency and accuracy.</p><p>• Manage medical billing operations, ensuring timely and accurate processing.</p><p>• Handle medical claims by reviewing, validating, and resolving discrepancies.</p><p>• Collaborate with team members to streamline billing functions and improve workflows.</p><p>• Ensure compliance with healthcare regulations and standards in all revenue cycle activities.</p><p>• Utilize data analysis to identify trends and recommend improvements in revenue cycle operations.</p><p>• Support the transition of revenue processes back in-house, ensuring seamless integration.</p><p>• Provide detailed reporting on billing and claims metrics to stakeholders.</p><p>• Assist in supply chain-related tasks when applicable to revenue cycle management.</p><p>• Maintain up-to-date knowledge of industry practices and regulatory changes.</p>
<p>We are looking for a skilled Medical Billing Specialist to join our team on a contract basis in Cincinnati, Ohio. This position plays a vital role in ensuring accurate and timely processing of medical claims for adult care and therapy services. The ideal candidate will bring expertise in billing systems, government healthcare payers, and commercial insurance claims.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit medical claims accurately and efficiently.</p><p>• Investigate and resolve claim denials, ensuring timely follow-up and appeals.</p><p>• Manage invoicing operations for both government payers and commercial insurers.</p><p>• Monitor reimbursement processes and address discrepancies to ensure proper payments.</p><p>• Handle Medicaid and Medicare billing with precision and compliance.</p><p>• Collaborate with team members to optimize billing workflows and minimize errors.</p><p>• Track claim statuses and maintain detailed records of billing activities.</p><p>• Ensure adherence to healthcare billing regulations and policies.</p><p>• Provide support in resolving complex billing issues that may arise.</p><p>• Communicate effectively with payers to clarify billing concerns or discrepancies.</p>
<p>Our client is looking for a dedicated Bodily Injury Claims Representative in the Lawrenceville, NJ area to manage non-litigation auto insurance claims, including uninsured and underinsured motorist cases. This role requires a strong understanding of insurance policies and the ability to assess claims effectively. </p><p><br></p><p>Salary is 60,000 - 79,000. </p><p><br></p><p>Benefits include medical, dental, and vision coverage, PTO, life insurance, and 401k. </p><p><br></p><p>Responsibilities:</p><p>• Investigate claims thoroughly to validate their authenticity, assess policy coverages, and determine if special investigations are necessary.</p><p>• Set appropriate reserves based on claim details and adjust them as new information becomes available.</p><p>• Negotiate settlements with claimants, attorneys, and other involved parties while adhering to company policies.</p><p>• Issue accurate payments promptly and ensure all transactions align with regulatory standards.</p><p>• Recognize potential fraud or questionable claims and escalate them to the special investigation unit when required.</p><p>• Maintain organized records and follow up regularly to ensure claims are resolved in a timely manner.</p><p>• Ensure compliance with state and local regulations, including NJ, PA, and Michigan Unfair Claims Practices guidelines.</p><p>• Complete other assigned duties as needed to support the claims process.</p>
We are looking for a dedicated Damage Claims Analyst to join our team in Indianapolis, Indiana. This long-term contract position offers an excellent opportunity to address a backlog of damage claims with precision and efficiency. If you have expertise in claims processing and a strong background in casualty and property damage claims, we encourage you to apply.<br><br>Responsibilities:<br>• Review and analyze damage claims to ensure accuracy and compliance with company standards.<br>• Process casualty and property damage claims efficiently using SAP systems.<br>• Investigate claims thoroughly to determine liability and assess damages.<br>• Communicate with clients, adjusters, and other stakeholders to gather necessary documentation and information.<br>• Maintain organized records of claims and ensure all documentation is complete.<br>• Resolve claims disputes by negotiating settlements where appropriate.<br>• Collaborate with team members to prioritize and address backlog cases.<br>• Ensure compliance with insurance regulations and company policies during claims processing.<br>• Provide timely updates to management regarding claim statuses and progress.<br>• Utilize analytical skills to identify trends or issues within claims processing workflows.
We are looking for an experienced Revenue Manager to oversee and optimize the revenue cycle operations within the healthcare sector. This role requires strong leadership skills to manage a team effectively, while ensuring the accuracy and efficiency of billing, claims processing, and payment posting. The ideal candidate will have a deep understanding of healthcare revenue cycles and accounts receivable processes.<br><br>Responsibilities:<br>• Supervise and guide the team in managing the revenue cycle, ensuring all processes are efficient and accurate.<br>• Oversee the resolution of denied claims and ensure timely rework to maximize revenue.<br>• Ensure accurate and timely billing operations, maintaining compliance with healthcare regulations.<br>• Manage the processing of claims and payment posting to maintain financial accuracy.<br>• Utilize healthcare systems such as NexGen and Etactics to streamline operations and enhance productivity.<br>• Develop and implement strategies to improve accounts receivable performance.<br>• Monitor key performance indicators related to revenue cycles and identify areas for improvement.<br>• Collaborate with other departments to ensure seamless integration of revenue cycle operations.<br>• Train and mentor staff to enhance their skills and knowledge in revenue management.<br>• Prepare and present reports on revenue cycle performance to senior leadership.
We are looking for a Billing Clerk to join our team in Roslyn Heights, New York. In this role, you will play a critical part in ensuring the accuracy and efficiency of billing processes within a healthcare setting. Your responsibilities will include managing insurance claims, addressing patient inquiries, and contributing to the overall success of the revenue cycle.<br><br>Responsibilities:<br>• Analyze and address denials and underpaid claims from insurance carriers based on contracted fee schedules.<br>• Submit appeals for inappropriate insurance denials in a timely manner.<br>• Communicate with patients to resolve questions about their claims, coverage, and billing concerns.<br>• Validate overpayment refund requests from insurance carriers to ensure accuracy.<br>• Monitor and identify trends among payors that impact revenue.<br>• Participate in individualized accounts receivable reviews with management.<br>• Determine coordination of benefits for patients with secondary and tertiary insurance coverage.<br>• Support various tasks related to revenue cycle operations as needed.<br>• Maintain constructive and positive interactions with patients, colleagues, and managers to foster a collaborative work environment.
<p>We are looking for a skilled Revenue Cycle Specialist to join our team in Emeryville, California. In this role, you will handle medical coding and contribute to the efficient management of claims and denials. This is a long-term contract position offering an opportunity to make a significant impact in the healthcare sector.</p><p><br></p><p>Responsibilities:</p><p>• Accurately apply ICD-10 and CPT codes to medical records and claims.</p><p>• Review and analyze outpatient coding to ensure compliance with regulatory standards.</p><p>• Manage and resolve insurance denials and claim discrepancies effectively.</p><p>• Collaborate with healthcare providers to validate coding accuracy and address coding-related inquiries.</p><p>• Monitor claims for commercial insurance to ensure timely processing and reimbursement.</p><p>• Identify trends in claim denials and implement corrective actions to minimize future issues.</p><p>• Assist in maintaining updated coding certifications and staying informed about changes in coding practices.</p><p>• Communicate with insurance companies to negotiate resolutions for denied claims.</p><p>• Support the revenue cycle team in optimizing workflows and achieving financial goals.</p><p><br></p><p>If you are interested in this role please apply today and call us at (510) 470-7450. This role will require your in-person presence in Emeryville, CA, a couple times per week, please do not apply if you are only looking for remote.</p>
<p>We are looking for a skilled Revenue Cycle Specialist to join our team in Emeryville, California. In this role, you will handle medical coding and contribute to the efficient management of claims and denials. This is a long-term contract position offering an opportunity to make a significant impact in the healthcare sector.</p><p><br></p><p>Responsibilities:</p><p>• Accurately apply ICD-10 and CPT codes to medical records and claims.</p><p>• Review and analyze outpatient coding to ensure compliance with regulatory standards.</p><p>• Manage and resolve insurance denials and claim discrepancies effectively.</p><p>• Collaborate with healthcare providers to validate coding accuracy and address coding-related inquiries.</p><p>• Monitor claims for commercial insurance to ensure timely processing and reimbursement.</p><p>• Identify trends in claim denials and implement corrective actions to minimize future issues.</p><p>• Assist in maintaining updated coding certifications and staying informed about changes in coding practices.</p><p>• Communicate with insurance companies to negotiate resolutions for denied claims.</p><p>• Support the revenue cycle team in optimizing workflows and achieving financial goals.</p><p><br></p><p>If you are interested in this role please apply today and call us at (510) 470-7450. This role will require your in-person presence in Emeryville, CA, a couple times per week, please do not apply if you are only looking for remote. </p>
<p>We are looking for a dedicated Medicaid Prior Authorization Coordinator to join our team! This is a contract opportunity in the healthcare industry, where you will play a vital role in managing Medicaid billing and service authorizations to ensure seamless operations. If you are detail-oriented, experienced in Medicaid billing, and thrive in a collaborative environment, we encourage you to apply.</p><p><br></p><p>Responsibilities:</p><ul><li>Organize and maintain documentation and digital records for Medicaid service authorizations and billing rates.</li><li>Make real-time updates to the billing system when resident information, authorization details, or fee structures change.</li><li>Monitor expiring authorizations and initiate the renewal process to guarantee uninterrupted claims processing and reimbursement.</li><li>Track and record relevant Medicaid data, including resident rosters, authorization periods, billable services, and financial obligations.</li><li>Enter and reconcile incoming Medicaid payments within the billing platform.</li><li>Prepare and process patient billing statements for required contributions under Medicaid guidelines.</li><li>Communicate with Medicaid provider representatives to resolve billing issues, clarify authorization requirements, and obtain necessary documentation.</li></ul>
<p>We are seeking a <strong>Senior Workers’ Compensation Claim Representative</strong> to join our team in Los Angeles, CA. This is an on-site, full-time temporary role. The <strong>Senior Workers’ Compensation Claim Representative</strong> will be responsible for managing all aspects of lost time claims for California, ensuring superior customer service and compliance with state regulations. As a <strong>Senior Workers’ Compensation Claim Representative</strong>, you’ll work closely with attorneys, vendors, and internal teams to deliver high-quality claims management services.</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Manage workers' compensation lost time claims from start to closure</li><li>Conduct comprehensive investigations and evaluate compensability</li><li>Communicate claim decisions to insureds, claimants, and attorneys</li><li>Administer statutory medical and indemnity benefits throughout claim lifecycle</li><li>Set and adjust reserves within authority limits</li><li>Collaborate with attorneys on hearings and litigation strategies</li><li>Direct nurse case managers, rehabilitation vendors, and telephonic case managers</li><li>Ensure compliance with all statutory filing requirements</li><li>Pursue subrogation opportunities where applicable</li><li>Maintain detailed file notes and participate in claim reviews</li></ul><p><br></p>
We are looking for a dedicated Claims Associate to join our team on a long-term contract basis in Sunrise, Florida. In this role, you will handle medical claims processing, member communications, and ensure compliance with industry standards. This position offers an opportunity to utilize your expertise in medical claims and billing while providing excellent customer service.<br><br>Responsibilities:<br>• Process new claims by setting them up, completing required forms, scanning documents, and ensuring all claims are accurately processed.<br>• Communicate with healthcare providers to gather additional documentation needed for claim evaluations.<br>• Assess coverage for submitted claims, verifying details through internal systems and attaching supporting documents.<br>• Send clear and thorough correspondence to members explaining the claim adjudication process.<br>• Provide empathetic and detail-oriented customer service, actively listening to member concerns.<br>• Act as a subject matter expert on benefit coverage and product knowledge, assisting members with inquiries.<br>• Maintain strict confidentiality and follow data security and authentication protocols when handling sensitive information.<br>• Organize and prioritize tasks to meet established service standards and benchmarks.<br>• Collaborate effectively in a fast-paced environment to ensure timely claim resolutions.<br>• Ensure compliance with relevant policies, procedures, and regulations while managing member and payment information.
<p>We are looking for an experienced Medical Biller/ AR specializing in medical operations to oversee revenue cycle processes and coding compliance. In this long-term contract role based in Scranton, Pennsylvania, you will play a critical part in ensuring the quality and integrity of medical billing and coding practices while maintaining compliance with federal and state regulations. This position offers an excellent opportunity to collaborate with healthcare professionals and drive operational excellence.</p><p><br></p><p>Responsibilities:</p><p>• Perform multi-specialty coding with precision to ensure timely submission of claims.</p><p>• Coordinate with clinical teams to address claim appeals, denials, and resolutions effectively.</p><p>• Develop and implement an audit process to validate clinical documentation and coded data integrity.</p><p>• Provide prompt responses to inquiries from patients, payers, and staff regarding claims and account submissions.</p><p>• Supervise the daily tasks of billing specialists to maintain workflow efficiency.</p><p>• Monitor accounts receivable over 120 days and implement strategies to reduce outstanding balances.</p><p>• Conduct trend analysis to ensure compliance with payer reimbursement agreements and resolve discrepancies.</p><p>• Prepare and analyze monthly aging reports to support financial oversight.</p><p>• Establish best practices to uphold data integrity and quality throughout the revenue cycle.</p><p>• Lead staff training initiatives to promote adherence to industry standards and compliance requirements.</p>
<p>Our client in Springfield, MA is seeking an experienced Insurance Follow-Up Specialist for a contract position. This is an excellent opportunity to contribute your expertise with a respected organization, ensuring the timely and accurate management of insurance claims and reimbursement processes.</p><p>Key Responsibilities:</p><ul><li>Investigate and resolve unpaid or delayed insurance claims</li><li>Communicate effectively with insurance carriers to obtain status updates, claim resolutions, and clarification of denials</li><li>Review and analyze explanation of benefits (EOBs) and remittance advice to determine appropriate follow-up</li><li>Appeal denied claims in accordance with payer-specific guidelines</li><li>Document all interactions and claim actions in the billing system accurately</li><li>Collaborate with internal teams, such as billing and collections, to ensure coordinated efforts</li><li>Maintain up-to-date knowledge of insurance regulations and payer requirements</li></ul><p><br></p>
