Claim Edit Specialist - Remote

With 150+ locations in 17 states, QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you. Our mission is to educate communities and healthcare professionals about the importance of skin health, including skin cancer prevention, risk factors, and how to achieve healthy skin through annual skin exams and dermatologic care.

About the role

Responsible for identifying and resolving third-party payer rejections. Will assist in resolution of edits/errors that may result in nonpayment of charges or prevent charges from being accepted by payers. Also responsible for entering bills/charges with input from certified coding team when necessary.

Responsibilities

• Manage claims returned which have failed scrub rules
• Identify and resolve payer rejections in a timely manner
• Enter charges/bills into EMR in coordination with certified coding team/Coding manager
• Monitor missing charges and communicate with RCM management as needed
• Must have knowledge of claim correction, electronic claim submission
• Ability to contact payers when necessary to resolve any issues
• Report any trends in a timely manner to RCM leadership that prevent successful claim submission
• Ability to effectively communicate with other departments such as Coding, AR/Follow-up, Patient Services and Posting

Requirements

• 1-3 years experience in a medical/insurance environment for physician practice or billing company
• Revenue Cycle Experience Preferred
• Complete Modernizing Medicine University courses within 6 months of hire
• Strict attention to detail
• Ability to meet deadlines in a fast paced, start-up, results-oriented environment, as well as excellent organizational skills
• Excellent verbal and written communication skills
• Proficient Microsoft Office Suite products, specifically Excel and ability to analyze large data sets
• Ability to collaborate and work in a team environment
• Applicants must be currently authorized to work in the United States on a full-time basis

Benefits

• Competitive Pay
• Comprehensive Health Coverage: Includes Medical, Dental, and Vision plans
• Generous 401(k) Plan: Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting
• Paid Time Off (PTO): Accrue PTO from day one, plus enjoy 6 paid holidays and 2 floating holidays each year
• Company-Paid Life Insurance: Peace of mind with basic life coverage, with the option for additional plans
• Disability Protection: Short-term and long-term disability coverage
• Additional Wellness Plans: Accident, critical illness, and identity theft protection plans
• Employee Assistance Program (EAP): Access confidential support for personal or work-related challenges
• Exclusive Employee Discounts: Save on products and services with special discounts just for you
• Referral Bonus Program: Earn bonuses by referring qualified candidates to join the team

Pay

Compensation Range: $19.35 - $27.33 per hour. Final offer will be based on a combination of skills, experience, location, and internal equity.