Claims & Billing Specialist

Job summary

The specialist determines coverage for medical, dental, and vision procedures by analyzing health policy provisions and investigating questionable claims. They also resolve billing inquiries, maintain accurate claim status updates in the CRM, and ensure compliance with HIPAA guidelines.

Job details

This role is located in our Denver Tech Center Office. This is not a remote position. WHAT YOU’LL DO: Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners Initiates investigation of questionable claims Resolves medical, dental, and vision claims and billing questions and issues by Provides information on year-to-date deductible, copay, and coinsurance activity to team members Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner Protects claimant information by following HIPAA guidelines Reports claim status updates in proprietary CRM and provides detailed information on each claim WHO YOU ARE: Our Navigation Operations is a fast-paced, dynamic, and growing environment. We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers. Strong communication skills, both written and verbal Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication Strong demonstration of critical thinking and problem-solving skills Bachelor’s degree in health sciences or related field and minimum of 2 years of experience as a medical claims specialist preferred COMPENSATION: $19.00 - $23.00/hr Compensation offered will be determined by geographic location, experience, and qualifications. CYBERSECURITY AWARENESS NOTICE In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment. ABOUT RIGHTWAY: Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them. Since its founding in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs. HOW WE LIVE OUR VALUES TO OUR TEAMMATES: We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our core values: 1) We are human, first Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding. 2) We redefine what is possible We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems. 3) We debate then commit We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team. 4) We cultivate grit Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity. 5) We seek to delight Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success. Rightway is proud to be an Equal Opportunity Employer that believes in the strength of diverse thought, beliefs, backgrounds, and education. We foster an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis protected by applicable law. All employment decisions are based on merit, qualifications, need, and performance.

What you’ll do

The specialist determines coverage for medical, dental, and vision procedures by analyzing health policy provisions and investigating questionable claims. They also resolve billing inquiries, maintain accurate claim status updates in the CRM, and ensure compliance with HIPAA guidelines.

Requirements

Candidates should possess strong communication, critical thinking, and problem-solving skills with professional experience in benefit plan interpretation and provider billing. A bachelor's degree in health sciences or a related field and at least 2 years of experience as a medical claims specialist are preferred.

Listed skills

• Customer service · Preferred
• Problem solving · Preferred
• Critical Thinking · Preferred
• Communication Skills · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Medical claims processing
• Benefit plan interpretation
• Provider billing practices
• Claim adjudication
• Critical thinking
• Problem-solving
• Communication skills
• Customer service
• HIPAA compliance
• CRM software
• Billing Inquiries
• Copayment Collection And Processing
• Empathy
• Resourcefulness
• Ingenuity
• Healthcare Industry Knowledge
• Solution-Oriented
• Business Decisions
• Resilience
• Medical Insurance Claims
• Adjudication
• Billing
• Customer Relationship Management
• Customer Service
• Communication
• Debating
• Critical Thinking
• Cyber Security
• Health Sciences
• Problem Solving
• Operations
• Tenacity
• Investigation
• Persistence
• Customer Inquiries

Job areas

• Healthcare
• Customer Service & Support
• Finance & Accounting
• Administrative
• Billing Claims Specialist
• Billing Specialist (General)
• Accounting and Bookkeeping Clerks
• Billing and Posting Clerks