Overview
A healthcare technology and physician enablement organization is seeking a Claims Billing Specialist based in Connecticut. The organization partners with medical groups, health plans, and health systems to improve physician practices and patient care through cloud-based technology and scalable operations. This role is vital to maintaining the financial health of physician practices by ensuring accurate and timely processing of medical claims.
Responsibilities
- Manage accounts receivable (AR), including aged AR analysis and root cause identification
- Develop and implement rules to prevent claim errors
- Investigate, resolve, and appeal claim denials, including communication with payers
- Make independent decisions on claim adjustments, resubmissions, and appeals
- Collaborate with internal teams and care center staff as needed
- Support large care center go-lives, occasionally requiring overnight travel
- Work with the Revenue Optimization team to ensure reimbursements align with payer contracts
- Perform denial analysis using the Trizetto platform
- Engage directly with practice consultants or physicians to optimize revenue cycle processes
- Drive daily and monthly departmental Key Performance Indicators (KPIs)
- Perform other duties as assigned
Requirements
- High School Diploma or equivalent
- Minimum 3 years of experience in a physician medical billing office
- Experience supporting medical claims billing and payers in Connecticut is required
- Preferred experience with Athena EHR
- Strong understanding of revenue cycle drivers and ability to resolve complex claims
- Experience with major payers such as Anthem, Medicare/Medicaid, United Healthcare, Carefirst
- Advanced Microsoft Excel skills (pivot tables, VLOOKUP, formulas) and proficiency with Google Sheets preferred
- Compliance with HIPAA rules and regulations
Compensation & Benefits
- Hourly base pay ranging from $24 to $26.45, excluding bonuses and benefits
- Eligible for an annual bonus targeted at 10%
- Base pay depends on experience, education, and geographic location
- Benefits include medical, dental, vision, life, and pet insurance
- 401K plan
- Paid time off
- Wellness programs
- Expense reimbursement for remote work-related internet costs (for eligible employees)
Location
This position is based in Connecticut and may require occasional overnight travel to support care center go-lives.