Reimbursement (Claims) Specialist

The Assistance Fund is looking for Reimbursement/Claim Specialists to join our team to help children and adults access the treatment they need to manage a life-threatening, chronic, or rare disease.

Start Date: TBD
Starting Hourly Rate: $19.75 per hour;
Full Time Position: Monday - Friday. 8:00 am - 5:00 pm
Hybrid Work Schedule after 5 weeks of in-office training has been completed. In-office requirements: once per month or as scheduled
Benefits effective the first of the month following 30 days of employment, include 100% Paid Health Benefits for you and your dependents. (See Below)
EOE Statement: We are an Equal Opportunity Employer.

Summary of Position:
The Reimbursement/Claims Specialist plays a crucial role in ensuring the accurate and timely processing of medical claims, contributing to the overall efficiency and success of the claims operation. This position involves reviewing, reconciling, and adjusting claims to ensure they meet established quality standards before final submission for payment. Specialists are expected to resolve claims promptly, communicate with insurance companies, patients, and service providers, and uphold compliance with all relevant regulatory standards, including HIPAA.

Responsibilities:

• Provide support by reviewing, researching, investigating, processing, and adjusting claims.
• Ensures Quality and Productivity standards are maintained.
• Review and process new claims.
• Process new claims and resolve them within the standard timeframe outlined in company policy, notifying leadership if this cannot be achieved.
• Liaising with insurance companies, patients, and service providers.
• Comply with HIPAA patient privacy and security regulation standards and applicable patient authentication and data security standards.
• Appropriately update Salesforce to reflect current statuses of program participants, including but not limited to all written or verbal communications, issues, and claims submissions.
• Regularly provide feedback on the effectiveness and soundness of program policies and procedures.
• Proven ability to multitask and maintain organization in a working from home office.
• Perform special projects on an as needed basis.