Claims Specialist at Wellpath

Franklin, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

11 May, 26

Salary

0.0

Posted On

10 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Customer Service, Attention to Detail, Analytical Skills, Medicare Knowledge, CPT4 Codes, ICD10 Codes, Billing, Communication, Collaboration, Problem Solving, Medical Terminology, HIPAA Compliance, Inventory Management, Payment Processing, Refund Requests

Industry

Hospitals and Health Care

Description

Why Wellpath Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. About this role As a Claims Specialist, you will be responsible for reviewing and adjudicating claims by verifying eligibility, approval of services, and accurate pricing according to established rules and processes. Your attention to detail, analytical skills, and ability to navigate complex systems will be critical to ensuring that claims are processed accurately and efficiently. Your commitment to providing high-quality customer service and collaborating effectively with cross-functional teams will contribute to the overall success of the claims department. What you bring to the table Education Must have high school diploma or GED Experience Minimum 1 year of Medicare claims processing experience with knowledge of CPT4 and ICD10 codes Minimum 1 year of experience working with CMS/professional and UB institutional claims Minimum 1 year of customer service experience Working knowledge of Medicare medical insurance terminology, procedure, diagnosis codes, fee schedules and HIPPA requirements Licenses/Certifications None What you will do Analyze claim determinations for payment or denial in accordance with established rules and processes. Monitor and manage assigned claim inventory to meet turnaround and productivity targets. Process claims from returned pended reports and those with claim edits. Manually price claims based on specified rates and guidelines. Follow up with providers regarding claim status, payment explanations, billing errors, and refund requests, while communicating any processing issues to Claims Leadership. Qualifications & Requirements Education Must have high school diploma or GED Experience Minimum 1 year of Medicare claims processing experience with knowledge of CPT4 and ICD10 codes Minimum 1 year of experience working with CMS/professional and UB institutional claims Minimum 1 year of customer service experience Working knowledge of Medicare medical insurance terminology, procedure, diagnosis codes, fee schedules and HIPPA requirements Licenses/Certifications None We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Responsibilities

As a Claims Specialist, you will review and adjudicate claims by verifying eligibility and pricing according to established rules. Your role will involve monitoring claim inventory and following up with providers regarding claim status and processing issues.