Claims Mgmt Specialist

About Crossover Health

Crossover Health is creating the future of health as it should be. A national, team-based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care, the company delivers an entirely new model of healthcare—Primary Health—built on the foundation of trusted relationships, an interdisciplinary care team approach, and outcomes-based payment. Crossover’s Primary Health model integrates primary care, physical medicine, mental health, health coaching, care navigation and more, and delivers care in surround-sound—in-person, virtually and via asynchronous messaging. Together we are building a community of members that embraces healthcare as a proactive part of their lifestyle.

Job Summary
 

The Claims Management Specialist is responsible for duties related to billing, payment collection, reconciliation, claims auditing and analysis.  This individual will be responsible for managing monthly reporting for rejected claims metrics and the billing metrics.

Job Responsibilities

• Performs all duties and responsibilities as outlined for a Claims Management Specialist

• Assists in researching and analyzing claims  issues,  performs true root cause analysis and determines next steps for resolution and process improvement 

• Manages data and reports on rejected claims metrics on a monthly cadence

• Manages  data and reports on the billing metrics to Account Management and Claims Management Supervisor on a monthly cadence 

• Submits and performs monthly audits for IC System collections 

• Responsible for reconciling members HSA checks in the portal and maintaining a member payment report. 

• May assume duties of answering claims related questions for members, in the Claims Management Supervisor’s absence

• Manages new workflows for MSFT

• Performs other duties assigned

 

Required Qualifications 

• Bachelor's Degree

• 2+ years of previous experience in billing /claims processing preferably in clinical setting

Preferred Qualifications

• Strong computer skills

• Strong attention to detail

• Prior billing and data entry experience

• Detail oriented, dependable, and able to manage multiple tasks and responsibilities simultaneously

• Be eager to learn and display professionalism

• Professional, motivated and energetic

Physical Job Requirements

• May require standing, walking and sitting for extended amounts of time.

• Occasionally lift and carry items weighing up to 50 lbs.

• Manual and finger dexterity and hand-eye coordination

• Includes full range of body motion including potential of handling and lifting patients.

• Requires corrected vision, hearing and speech within normal ranges. Must be able to effectively communicate with patients and team members.

The base pay range for this position is $21.96 to $29 per hour. Pay range may vary depending on work location, applicable knowledge, skills, and experience. This position may be eligible for an annual bonus opportunity and comprehensive benefits package that includes Medical Insurance, Dental Insurance, Vision Insurance, Short- and Long-Term Disability, Life Insurance, Paid Time Off and 401K.

Crossover Health is committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability. If you need assistance or an accommodation due to a disability, you may email us at [email protected].

To all recruitment agencies: We do not accept unsolicited agency resumes and are not responsible for any fees related to unsolicited resumes.

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