Overview
A public sector solutions and operations improvement firm is seeking a professional to join their Health team. The team supports health, education, and human services agencies by addressing financial, regulatory, and operational challenges to improve healthcare delivery and compliance. The organization provides services including third-party administration, claims processing, consulting, cost allocation, and healthcare access strategies.
Responsibilities
- Monitor and analyze claim files and paper claims for Commercial, Medicare, and Medicaid programs
- Identify and resolve claims stuck in "new status" that have not been billed
- Review and address rejections from 277 files; analyze data trends and report to supervisors or managers
- Manage denials from 835 files; analyze trends and advise supervisors or managers
- Process quality assurance and mail statements
- Monitor and work on outstanding accounts receivable; analyze trends and report findings
- Respond to provider, submitter, and client inquiries related to claims and claims issues
- Perform quality assurance audits
- Enroll providers in clearinghouse systems
- Perform other duties relevant to revenue cycle management (RCM) of the project as assigned
Required Skills
- Strong organizational and data analysis abilities
- Ability to meet tight deadlines and execute tasks accurately
- Capability to follow outlined processes and escalate issues promptly
- High attention to detail and accuracy
- Proficiency in Microsoft Office, especially Excel
- Understanding of industry standards such as 837, 999, 277, and 835 files, including rejection and denial management
- Problem-solving skills with the ability to identify issues and recommend solutions proactively
Qualifications
- High School Diploma or equivalent required
- 2 to 3 years of relevant experience
- Coding certificate is a plus
Supervisory Responsibility
Working Conditions
Compensation & Benefits
- Hourly pay range: $22.00 - $24.00
- Benefits include medical and dental care, 401(k), paid time off, parental leave, and bereavement leave
- Compensation varies based on location, role, skill set, and experience
- The employer does not sponsor work authorization for newly hired foreign national workers, including H-1B sponsorship
Equal Employment Opportunity
The organization is an Equal Opportunity Employer committed to diversity and inclusion. Employment decisions are based on merit, business needs, job requirements, and individual qualifications without discrimination based on race, color, religion, national origin, sex, gender identity or expression, age, disability, sexual orientation, marital status, military service, citizenship status, family medical history, or any other protected status under applicable laws.