IDR Claim Specialist

About the role

Gryphon Healthcare is a Houston-based revenue cycle management company serving healthcare providers nationwide. We pride ourselves on delivering results through accountability, transparency, and a hands-on approach, what we call "The Gryphon Difference." Our team is collaborative, driven, and committed to supporting one another while delivering exceptional outcomes for our clients.

Duties and responsibilities

• Work daily reports to identify claims eligible for Mediation/Arbitration by identifying insurance type, eligible dates of service and EOB check dates.
• Prepare Arbitration/Mediation documentation packets for filing with Texas Department of Insurance (TDI) and/or IDR by compiling required components, review for accuracy and recording and uploading to appropriate drive/system.
• Record and track all required case information via applicable system (i.e. Smartsheets, Excel, Word).
• Identify and communicate IDR / TDI trends with Director of Revenue Cycle Management & Legal Team.
• Participates in team meetings and provides input and feedback to support Legal Team goals, objectives, and timelines.
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations.
• Provides support as needed to all members of the billing and auxiliary departments at Gryphon Healthcare.
• Demonstrates good customer service standards when communicating with internal and/or external customers.

Competencies

• Attention to Detail – Completes all work according to organization procedures and standards. Double checks the accuracy of information and work product.
• Teamwork - Strong interpersonal and communications skills to be able to work successfully in a team-oriented environment. Active participant within the team and contributes to achieving team objectives
• Oral/Written Communication Skills – Able to communicate information and ideas in a clear concise manner both orally and in written form. Able to convey complex information clearly. Takes time to listen to and understand the perspective of others and propose solutions.
• Computer Skills - Understands and fully utilizes computer systems used in the technological stream of researching and entering claim information including but not limited to: Microsoft Office (Excel, Outlook, Teams) and various billing systems and insurance carrier portals.
• Time Management - Well organized, self-motivated, and able to work with minimal supervision, meet quality and productivity standards
• Professionalism - Demonstrates behaviors consistent with the organization’s core values. Displays an appearance in compliance with the dress code policy
• Ethics and Integrity – Accepts responsibility for one’s own decisions, actions, and failures. Demonstrates knowledge, skills, and ability to determine right from wrong.

Qualifications

• High School graduate or equivalent required.
• Previous experience in medical billing preferred.
• Ability to accurately interpret Eligibility of Benefits (EOB)
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations
• EMR, EDI and Commercial Insurance Company systems
• Ability to represent the company in a professional manner and handle patient issues with sensitivity and confidentiality
• Detail oriented and accurate data entry skills
• Strong organizational skills and the ability to prioritize workload
• Must be able to write and speak effectively in English
• Must demonstrate interpersonal skills with all levels of the billing and management team
• Must be able to work well in a team environment
• Basic computer literacy that includes keyboarding skills with the ability to utilize Outlook and to navigate in a Windows environment.
• Ability to work in a fast-paced, high volume and dynamic environment. Requires flexible work hours in order to meet the needs of the team and company.