Billing and Claims Specialist
Rightway Healthcare · Denver, CO
Handles medical, dental, and vision claims and billing questions for members by interpreting health policy coverage. Gathers information from providers, employers, and carriers, investigates questionable claims, and keeps claim status updated in a CRM while protecting claimant information.
What you'll do
- Determine coverage for medical, dental, and vision procedures from member health policies
- Gather information from claimants, physicians, employers, hospitals, and carriers
- Investigate questionable claims
- Resolve claims and billing questions and issues
- Update claim status in the proprietary CRM
Requirements
- Strong written and verbal communication skills
- Professional experience with benefit plan interpretation, provider billing practices, and claim adjudication
- Strong critical thinking and problem-solving skills
- Ability to work onsite 5 days a week in Denver Tech Center office
Nice to have
- Bachelor's degree in health sciences or related field
- 2+ years of experience as a medical claims specialist
Skills
Outlined skills are listed as required.
Full original description
This is an onsite, 5 days a week role 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 - $24.00/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 $300mm from investors including Khosla Ventures, Thrive Capital, Francisco Partners, 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, firstOur 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 possibleWe 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 commitWe 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 gritChanging 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 delightHealthcare 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.