About this opportunity
Rising Medical Solutions lists this Medical Claims Specialist - Remote opportunity in milwaukee, Wisconsin. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Overview
The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring compliance and enhancing client relationships.
In this job, you will
Maintain ongoing knowledge of program requirements
Analyze and process claims for accuracy, eligibility, and benefits coverage
Retain and strengthen relationships with clients and members
Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
Correspond to verify if the amounts are related to the claim
Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
Adhere to quality assurance objectives and goals
Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising\'s returns from administration services
Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
Keep management updated on activities, issues and developments
Document all claims decisions and communications with members in the system accurately and timely
Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
Special projects as assigned by management
Reports to
Program Manager
Qualifications
Education/Training
High school diploma required; Associate\'s or Bachelor\'s degree preferred
CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred
Experience
2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position
Skills/Competencies
Knowledge of Group Health Insurance, Workers\' Compensation, No-Fault, and/or Liability industry
Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices
Well-developed time-management, organization, and prioritization skills
Excellent analytical skills
Customer-service orientation
Excellent oral and written communication skills
Knowledge of medical billing procedures
Ability to gather data, compile information, and prepare summary reports
Strong interpersonal and conflict resolutions skills
Ability to work independently and as part of a team in a fast-paced, multi-faceted environment
Demonstrated persistence and attention to detail
Physical/Mental Demands
Remaining in a seated position
Entering text or data into a computer
Visual Acuity
Talking
Hearing
Repetitive arm, hand, and finger motions
Working remotely some or all of the time
Benefits
Pay Range: $
Health insurance (4 different plans to choose from)
Dental
Vision
Paid time off (PTO) or Flexible Time Off (FTO)
401(k)
Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
Voluntary Life Insurance and Short-Term Disability Insurance
Flexible Spending Accounts (FSA)
Employee Assistance Program (EAP)
Rise Well Wellness Program
Professional Development Reimbursement Program (PDRP)
You will be part of our new Elevate program designed to recognize and reward employees for their hard work
About Us
Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations.
Continuous technological improvement
Entrepreneurial attitude
Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what\'s really important, and keeping a sense of humor
Responding quickly to client needs
Being the best, not the biggest
Seniority level
Associate
Employment type
Full-time
Job function
Administrative
Industries: IT Services and IT Consulting
Referral note: Referrals increase your chances of interviewing at Rising Medical Solutions by 2x
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Worksite address
milwaukee, WI, 53244, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.