Claims Specialist at Wellpath

Franklin, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

15 May, 26

Salary

0.0

Posted On

14 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Claims Processing, CPT/HCPCS Coding, ICD-10 Coding, CMS Guidelines, Customer Service, Communication, Microsoft Office Suite, Attention To Detail, Organizational Skills, Claims Analysis, Denial Resolution, Payer Guidelines, Regulatory Requirements

Industry

Hospitals and Health Care

Description

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports:• Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us 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. How you make a difference The Claims Specialist is responsible for the accurate and timely processing of medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory requirements. The role focuses on reviewing, verifying, and analyzing claim information to determine appropriate payment or denial. This position involves processing new, pended, edited, and returned claims to ensure resolution and completion. The Claims Specialist analyzes and resolves denials, rejections, and payment discrepancies while maintaining quality and turnaround standards. The role also includes communicating with internal teams, providers, payers, and Claims Leadership to support efficient and accurate claim processing. Key Responsibilities Analyze, verify, and process medical claims to determine accurate payment or denial based on established rules and rates. Review claim data, coding, documentation, edits, and pended reports to ensure completeness and compliance. Resolve claim denials, rejections, and payment discrepancies through detailed analysis and follow-up. Communicate with internal teams, providers, payers, and Claims Leadership to address claim-related issues and barriers. Maintain productivity, quality, and turnaround standards while providing courteous and responsive customer service. Qualifications & Requirements Education High school diploma or GED required Experience 3-5 years of medical claims processing experience required. Working knowledge of CPT/HCPCS and ICD-10 coding standards. Familiarity with CMS guidelines and regulations. Strong Customer service and communication skills. Proficiency in the Microsoft Office Suite (Outlook, Word, Excel). High level of attention to detail with strong organizational skills. High-volume claims environment. Licenses/Certifications None required 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

The Claims Specialist is responsible for the accurate and timely processing of medical claims according to established rules, coding standards, and payer guidelines, focusing on reviewing, verifying, and analyzing claim information to determine payment or denial. This role involves processing various claim types and resolving denials, rejections, and payment discrepancies while communicating with internal and external stakeholders.