Claim Edit Specialist - Remote
About Our Client
The organization operates as a large dermatology network with more than 150 locations across 17 states, focusing on skin health education, prevention, and comprehensive dermatologic care. It works to improve access to timely, high-quality care while supporting healthcare professionals and communities through education on skin cancer prevention and healthy skin practices.
About the Opportunity
The Claim Edit Specialist supports the revenue cycle by managing and resolving third-party payer rejections to help ensure accurate and timely claim processing. This role identifies billing issues, coordinates corrections with coding and revenue cycle teams, communicates with payers, and monitors trends that may affect successful claim submission.
Responsibilities
- Manage claims returned due to failed claim scrub rules.
- Identify and resolve payer rejections promptly and accurately.
- Enter charges and bills into the electronic medical record system in coordination with coding staff.
- Monitor accounts for missing charges and communicate issues to revenue cycle management as needed.
- Apply knowledge of claim correction procedures and electronic claim submission processes.
- Contact third-party payers to investigate and resolve claim issues when necessary.
- Identify and report trends that may impede successful claim submission to revenue cycle leadership.
- Collaborate effectively with Coding, Accounts Receivable, Patient Services, Posting, and other internal departments.
- Maintain accurate documentation and follow established billing and compliance procedures.
Requirements
- 1 to 3 years of experience in a medical or insurance environment supporting physician practices or billing companies.
- Revenue cycle experience preferred.
- Completion of Modernizing Medicine University courses within six months of hire.
- Strong attention to detail and organizational skills.
- Ability to meet deadlines and manage multiple priorities in a fast-paced environment.
- Excellent verbal and written communication skills.
- Proficiency with Microsoft Office Suite, particularly Excel for data analysis.
- Ability to collaborate effectively and contribute to a team-oriented environment.
- Strong problem-solving and analytical skills.
Pay Range and Compensation Package
Compensation range of $19.35 to $27.33 per hour, based on skills, experience, location, and internal equity.
Benefits & Perks
- Medical, dental, and vision insurance.
- 401(k) plan with company matching.
- Paid time off, including holidays and floating holidays.
- Company-paid life insurance with options for additional coverage.
- Short-term and long-term disability coverage.
- Wellness benefits, including accident, critical illness, and identity theft protection.
- Employee Assistance Program providing confidential support.
- Exclusive employee discounts.
- Referral bonus program.