SENIOR CLAIMS SPECIALIST

Remote
$45,000-$55,000
Metro Vein Centers
Healthy legs feel better.
Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. Our industry-leading team of board-certified physicians is on a mission to meaningfully improve people’s quality of life by relieving the often painful and highly treatable symptoms of vein disease—such as varicose veins and heavy, aching, swollen legs. We currently operate 50+ clinics throughout 7 states with a vision of becoming the go-to vein care choice for patients nationwide.

HOW YOU’LL MAKE A DIFFERENCE:

Metro Vein Centers (MVC) is seeking a highly skilled and detail-oriented Senior Claims Specialist to join our Revenue Cycle Department. This position plays a critical role in optimizing the claims management process, ensuring compliance, and enhancing operational efficiency. The Senior Claims Specialist will handle escalated claims, audit the performance of Accounts Receivable (AR) vendor partners and MVC staff, investigate denial trends to identify root causes, and develop standard operating procedures (SOPs) to drive process improvements. The ideal candidate will serve as a pivotal resource in identifying opportunities for streamlining workflows and reducing inefficiencies within the claims process. This role requires a proactive problem-solver who can collaborate across departments to implement effective solutions. Additionally, the Senior Claims Specialist will be instrumental in mentoring team members and fostering a culture of continuous improvement within the Revenue Cycle Department.

• Review and resolve escalated claims, including high-complexity or high-dollar claims, ensuring accuracy, timeliness, and compliance with payer guidelines in a multistate practice. .
• Analyze denied or underpaid claims to identify patterns and root causes, providing actionable recommendations to reduce future denials.
• Audit AR vendor partner performance and internal staff processes to ensure compliance with MVC standards and contractual obligations.
• Create, document, and implement SOPs for claims processing, denial management, and AR follow-up to improve efficiency and reduce errors.
• Monitor and report on denial trends, preparing detailed performance reports and dashboards for leadership.
• Work closely with payers to facilitate appeals and expedite resolution of complex claims.
• Stay current with payer policies, coding updates, and regulatory changes affecting claims and reimbursement, sharing knowledge with the team.
• Provide training and mentorship to staff on claims processes, payer guidelines, and best practices to enhance team capabilities.
• Partner with Patient Financial Services Supervisor on special projects.

REQUIRED EDUCATION AND EXPERIENCE

• High School Diploma or equivalent
• Minimum of 3 years of experience in physician claims management (CMS-1500), revenue cycle operations, or a related role.

PREFERRED EDUCATION AND EXPERIENCE

• Experience with Athena Practice
• Experience working with a multistate medical practice
• Experience developing and implementing SOPs and process improvement initiatives.
• Experience working with RCM vendors: onshore or offshore

• Review and resolve escalated claims, including high-complexity or high-dollar claims, ensuring accuracy, timeliness, and compliance with payer guidelines in a multistate practice. .
• Analyze denied or underpaid claims to identify patterns and root causes, providing actionable recommendations to reduce future denials.
• Audit AR vendor partner performance and internal staff processes to ensure compliance with MVC standards and contractual obligations.
• Create, document, and implement SOPs for claims processing, denial management, and AR follow-up to improve efficiency and reduce errors.
• Monitor and report on denial trends, preparing detailed performance reports and dashboards for leadership.
• Work closely with payers to facilitate appeals and expedite resolution of complex claims.
• Stay current with payer policies, coding updates, and regulatory changes affecting claims and reimbursement, sharing knowledge with the team.
• Provide training and mentorship to staff on claims processes, payer guidelines, and best practices to enhance team capabilities.
• Partner with Patient Financial Services Supervisor on special projects