medical insurance claims specialist

Ensemble Health Partners

<div><div>Thank you for considering a career at Ensemble Health Partners!</div><div></div><div>
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.</div><div></div><div>
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!</div><div></div><div>
O.N.E Purpose:</div><ul><li><div>
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.</div></li><li><div>
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.</div></li><li><div>
Striving for Excellence: Execute at a high level by demonstrating our &ldquo;Best in KLAS&rdquo; Ensemble Difference Principles and consistently delivering outstanding results.</div></li></ul><div></div><div>
The Opportunity:</div><div></div><div>
CAREER OPPORTUNITY OFFERING</div><ul><li>
Bonus Incentives</li><li>
Paid Certifications</li><li>
Tuition Reimbursement</li><li>
Comprehensive Benefits</li><li>
Career Advancement</li><li>
This position pays between $16.50 - $21.35 /hr based on experience</li></ul><div></div><div>
The Denials Specialist is responsible for clinically related claim denials across Ensemble Health Partners. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification and submitting appeals in a timely manner.</div><div></div><div>
Essential Job Functions:</div><ul><li>
Analyze claims, remittances, denial letters, and contact payers to effectively determine root causes for denials and steps to resolution</li></ul><ul><li>
Analyzing the claims and determining if appeal is necessary</li></ul><ul><li>
Preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records</li></ul><ul><li>
Acting as a liaison between healthcare providers for any additional medical documentation or clarification and submitting appeals in a timely manner</li></ul><ul><li>
Knowledgeable in Revenue Cycle terminology and processes; able to effectively triage denials for appropriate actions to be taken</li></ul><ul><li>
Meets quality and productivity standards - able to accurately type, format, and draft appeal letters</li></ul><div></div><div>
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.</div><div></div><div>
Job Experience:</div><div>
1 to 3 Years</div><div></div><div>
Education Level:</div><div>
Associate&rsquo;s degree or Equivalent Experience</div><div></div><div>
Knowledge, Skills and Abilities:</div><ul><li>
2 years of denials or accounts receivable</li><li>
Type 35 wpm</li><li>
Experience in hospital operations, chart audit/review, and provider relations</li></ul><div></div><div>
Join an award-winning company</div><div></div><div>
Five-time winner of &ldquo;Best in KLAS&rdquo; 2020-2022, 2024-2025</div><div>
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024</div><div>
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024</div><div>
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024</div><div>
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023</div><div>
Energage Top Workplaces USA 2022-2024</div><div>
Fortune Media Best Workplaces in Healthcare 2024</div><div>
Monster Top Workplace for Remote Work 2024</div><div>
Great Place to Work certified 2023-2024</div><ul><li><div>
Innovation</div></li><li><div>
Work-Life Flexibility</div></li><li><div>
Leadership</div></li><li><div>
Purpose + Values</div></li></ul><div></div><div>
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:</div><ul><li>
Associate Benefits &ndash; We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.</li><li><div>
Our Culture &ndash; Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.</div></li><li><div>
Growth &ndash; We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.</div></li><li><div>
Recognition &ndash; We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.</div></li></ul><div></div><div>
Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.</div><div></div><div>
Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact <div>TA@ensemblehp.com</div>.</div><div></div><div>
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role&rsquo;s range.</div><div></div><div><div>
EEOC &ndash; Know Your Rights</div><br>
<div>FMLA Rights - English</div></div><div><div>
La FMLA Espa&ntilde;ol</div></div><div><div>
E-Verify Participating Employer</div> (English and Spanish)</div><div><div>
Know your Rights</div></div></div>

Denials Specialist

Interactive Insurance Brokers LLC

An insurance brokerage firm in Dubai is seeking a Claims Operations Supervisor for Pet Insurance to manage claims processing and oversee departmental operations. The ideal candidate will have veterinary clinic experience, excellent communication skills, and a strong customer service orientation. Responsibilities include educating pet owners, managing the claims process, and training sales teams on pet insurance products.

Pet Insurance Claims Operations Leader - Dubai

The Graduate Recruitment Specialist Ltd. Web

<p>Everyone has a voice and the chance to make a difference. Their training ensures everyone has the opportunity to gain funded professional qualifications and continuous personal development. Teamwork is a fundamental part of how they work and as a collective unit we focus on achieving their goals together. Having fun, working hard and sharing in the company's success ensures they keep true to their ethos.</p><p><strong>NATURE OF BUSINESS:</strong></p><p>Our client offers a fresh approach to a traditionally overlooked sector. They are passionate about putting their customers first above all things. They are a true leader within their sector with a team that has more than a century of combined experience. This makes them the go-to experts for their client's third-party damage claims, no matter how bizarre or quirky. Employing their own team of specialist site operatives, allowing them to handle everything from claims to repairs in one smooth process.</p><p><strong>Company Accreditations:</strong></p><p>The Client is passionate about training within their organisation. Their employees can progress their professional qualifications and continually develop their skills within the industry.</p><p>With roots firmly in repair and construction, dealing with unusual and sometimes unconventional projects, they have set out to become a repair and construction company with a real difference.</p><p>They are members of the Charted Institute of Building (CIOB) and undertake professional qualifications within the membership to expand knowledge and experience in the industry. Their staff members also undertake examinations and progression through the Charted Institute of Insurance (CII) and other professional bodies dependent on the role.</p><p>They are members of the Charted Institute of Building (CIOB) and undertake professional qualifications within the membership to expand knowledge and experience in the industry. Their staff members also undertake examinations and progression through the Charted Institute of Insurance (CII) and other professional bodies dependent on the role.</p><p>Our client has split their intervention team in two due to business growth - SME (Subject Matter Experts) and normal intervention. For the SME side of the team, they are looking to bring someone into the business able to investigate circumstances around a claim. This would be for high value claims.</p><p>Our client is looking to recruit a high calibre professional with excellent communication and investigative skills. You will be someone who is comfortable talking to people from all backgrounds and levels and be able to adapt accordingly. You will be looking to establish a permanent career within the team and be part of the exciting future of this organisation.</p><p>As a member of this team, you will be allocated cases to investigate, dealing with a range of different clients. You will be required to investigate each case and ensure you have all the data correct, this will involve communication with the client, being able to listen and ask the right questions.</p><p>If you are looking for a challenging business focused role that requires excellent attention to detail and offers variety, progression routes and training with a dynamic environment this is a role to be considered.</p> Skills Required <ul><li>Proven client/customer focused experience in an office environment</li><li>Experience in the insurance sector</li><li>Ability to investigate and actively listen</li><li>The ability to work when required in a fast -paced environment</li><li>Emotionally intelligent</li><li>Experience dealing with customers over the telephone</li><li>Ability to work to deadlines</li><li>Personable and approachable</li><li>Ability to communicate effectively on all levels</li><li>Excellent attention to detail</li><li>IT literate and able to pick up new systems</li><li>Ability to work on own initiative and manage own workload as well as add real value to the team</li><li>Excellent progression.</li><li>Company pension which increases with time served</li><li>An industry leading maternity policy</li><li>£500 wellbeing payment at annual review</li><li>Loyalty bonus at milestone years</li><li>Support to continue training and paid for professional qualifications</li><li>Access to a Rising Stars programme and equal support for mental and physical wellbeing.</li></ul><p><strong>HOURS OF WORK: </strong>8.45 - 5.00pm Monday to Friday with a break for lunch</p><p><strong>HOLIDAY: </strong>25 days plus bank holidays, an extra 16 hours of time off in lieu taken at no more than two-hour slots which equates to the total of 27 days plus bank holidays. An additional day is also given for your Birthday if it falls on a weekday.</p><p>Please complete the below web submission form and a consultant will be in touch soon.</p>

Subject Matter Expert - Claims

RAK Ceramics

<div>
 <p>
  <strong>
   Who We Are
  </strong>
 </p>
 <p>
  We help to create icons. We help to build marvels. Our products feature in some of the most iconic buildings in the world.
 </p>
 <p>
  <strong>
   RAK Ceramics
  </strong>
  is one of the largest ceramics brands globally, specializing in ceramic and gres porcelain wall and floor tiles, sanitaryware, faucets, and tableware. Headquartered in the United Arab Emirates, we serve clients in over
  <strong>
   150 countries
  </strong>
  through operational hubs in
  <strong>
   Europe, the Middle East and North Africa, Asia, North &amp; South America, and Australia
  </strong>
  .
 </p>
 <p>
  With over
  <strong>
   12,000 employees from 40+ nationalities
  </strong>
  , we are a truly global and diverse organization. RAK Ceramics is publicly listed on the
  <strong>
   Abu Dhabi Securities Exchange (ADX)
  </strong>
  and the
  <strong>
   Dhaka Stock Exchange
  </strong>
  .
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   The Role
  </strong>
 </p>
 <p>
  We are looking for a
  <strong>
   Procurement Specialist - Insurance
  </strong>
  to manage end-to-end procurement activities for
  <strong>
   insurance
  </strong>
  , interior fit-outs, exhibition stands, and other IT, Marcom, and insurance-related categories. The role is responsible for vendor management, contract negotiations, strategic sourcing, and ensuring timely, cost-effective procurement in line with company policies.
 </p>
 <p>
  <br/>
 </p>
 <p>
  This position plays a key role in enhancing procurement efficiency, driving cost optimization, and supporting multiple internal stakeholders across the business.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   What You Will Be Doing
  </strong>
 </p>
 <ul>
  <li>
   Manage daily import and local procurement activities with full ownership of the end-to-end process
  </li>
  <li>
   Lead insurance procurement, including policy management and claims handling
  </li>
  <li>
   Handle procurement for exhibition stands (local and global) and interior fit-out/maintenance
  </li>
  <li>
   Develop new vendors, evaluate contracts, and optimize commercial and operational risks
  </li>
  <li>
   Conduct price analysis, negotiate terms, and secure competitive agreements
  </li>
  <li>
   Implement MSAs, SOWs, and variations in alignment with the company&rsquo;s legal framework
  </li>
  <li>
   Follow sustainable procurement practices for all goods and services
  </li>
  <li>
   Support strategic sourcing, supplier selection, and maintain the contract repository
  </li>
  <li>
   Coordinate with suppliers locally and internationally to resolve quality or delivery issues
  </li>
  <li>
   Monitor monthly costs and ensure alignment with budgets
  </li>
  <li>
   Drive process improvement initiatives to eliminate waste and achieve cost savings
  </li>
  <li>
   Manage logistics coordination and implement material management policies
  </li>
  <li>
   Build and maintain strong relationships with internal stakeholders and vendors
  </li>
  <li>
   Analyze market trends, pricing, availability, lead times, and innovations
  </li>
  <li>
   Perform data analysis related to OTIF, rejections, and NPD
  </li>
  <li>
   Lead initiatives to improve the total cost of ownership (TCO)
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   What We Are Looking For
  </strong>
 </p>
 <p>
  Some of the key competencies required for the role include:
 </p>
 <p>
  <strong>
   Functional
  </strong>
 </p>
 <ul>
  <li>
   Strong understanding of Incoterms
  </li>
  <li>
   Strong negotiation skills and ability to represent the company with vendors
  </li>
  <li>
   Ability to draft and review contracts
  </li>
  <li>
   Analytical capability to identify root causes of delays or deviations
  </li>
  <li>
   Expertise in full-cycle procurement
  </li>
  <li>
   Knowledge of PR&ndash;PO processes
  </li>
  <li>
   Proficiency in SAP MM
  </li>
 </ul>
 <p>
  <strong>
   Behavioural
  </strong>
 </p>
 <ul>
  <li>
   Strong communication and stakeholder management abilities
  </li>
  <li>
   Effective decision-making skills
  </li>
  <li>
   Ability to perform under pressure and manage competing priorities
  </li>
  <li>
   Strong organizational and prioritization skills
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Our Ideal Match
  </strong>
 </p>
 <ul>
  <li>
   MBA or related field; Bachelor&rsquo;s in Civil Engineering is a plus
  </li>
  <li>
   3&ndash;4 years of procurement experience within a large manufacturing organization (4&ndash;6 years preferred)
  </li>
  <li>
   Experience in insurance procurement is an advantage
  </li>
  <li>
   Fluent in English; multilingual preferred
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   RAK Ceramics is an Equal Opportunity Employer.
  </strong>
 </p>
 <p>
  We do not discriminate on the basis of race, colour, religion, gender, nationality, disability, age, or marital status.
 </p>
</div>


Procurement Specialist - Insurance

Luster National

<div><p><b>About the Position</b></p>
<p>
We are seeking an experienced <b>Claims and</b> <b>Change Specialist</b> to join our team on major NY transit and infrastructure projects. This role is critical in managing project changes to ensure compliance with contractual requirements, budgetary constraints, and schedule commitments. The ideal candidate will have a strong background in claims and change management processes within large-scale heavy civil or transportation projects.</p>
<p>
This is a long-term, on-site position located in New York City.</p>
<p><b>
Responsibilities </b><i>may include, but are not limited to, the following:</i></p>
<ul>
<li>Oversee and manage the change control process for a large-scale heavy-civil design-build contract, ensuring alignment with contract terms and client procedures while utilizing Unifier and other required tracking tools.</li>
<li>Evaluate and confirm change requests submitted by the Design-Builder, adhering to contractual timelines and client guidelines.</li>
<li>Conduct research and provide recommendations regarding the validity and merit of Notices of Change.</li>
<li>Develop comprehensive documentation for each change request, including cost and schedule impact assessments in collaboration with project controls teams (estimators and schedulers).</li>
<li>Partner with estimators, schedulers, and construction management teams to analyze potential impacts.</li>
<li>Keep accurate and up-to-date records of all change orders and approvals within the authorized project change log.</li>
<li>Lead meetings to address changes, resolve disputes, or clarify issues in coordination with construction management and contract administration teams.</li>
<li>Deliver consistent status updates and reports to the project team on a weekly basis or more frequently as required.</li>
<li>Assist in negotiating change orders by organizing sessions with the Design-Builder and PMT staff and preparing negotiation summaries.</li>
<li>Ensure adherence to client C&amp;D standards and procurement requirements throughout all change management activities.</li>
<li>Provide support for audits and reviews related to change control processes.</li>
</ul>
<p><b>Attributes</b></p>
<ul>
<li>Excellent written and verbal communication and interpersonal skills. You are a persuasive communicator and skilled negotiator who builds trust across technical, legal, and executive audiences.</li>
<li>Excellent multi-tasking and organizational skills.</li>
<li>Strong analytical mindset with the ability to translate schedule and cost data into actionable commercial strategies.</li>
<li>Collaborative mindset that fosters teamwork, trust, and positive relationships and thrives in multidiscipline, owner-representative environments.</li>
<li>Natural curiosity, problem-solving abilities, and a passion for continuous improvement.</li>
</ul>
<p><b>Minimum Qualifications</b></p>
<ul>
<li>Bachelor's degree in Engineering, Construction Management, Business, or related field, or equivalent combination of education/experience.</li>
<li>7+ years of hands-on contracts, change order, or claims management experience on heavy-civil infrastructure programs. major transit or rail programs, including at least one project exceeding $500 million total contract value.</li>
<li>Experience with alternative delivery methods (e.g., DB, CM/GC, P3) and associated risk-allocation mechanisms.</li>
<li>Demonstrated successful negotiation strategy and achieving favorable commercial outcomes for public sector transit owners or operators.</li>
<li>Ability to interpret design documents, schedules, cost reports, and commercial terms to build clear entitlement narratives and quantum analyses.</li>
<li>Proficiency with industry standard project management, schedule/cost and/or EDMS tools (e.g., P6, EcoSys, Unifier, MS Project, Bluebeam, etc.)</li>
<li>Proficiency with Microsoft Office Suite/Office 365 (e.g., Outlook, Teams, Word, Excel, PowerPoint, etc.).</li>
</ul>
<p><b>Preferred Qualifications</b></p>
<ul>
<li>Master's degree in Engineering, Construction Management, Construction Law, or MBA.</li>
<li>One or more of the following certifications: Project Management Professional (PMP through PMI), National Contract Management Association (NCMA) certifications such as Certified Professional Contracts Manager (CPCM) or Certified Contract Manager (CCM).</li>
<li>Prior success steering claims through mediation, DRB, or litigation.</li>
<li>Proficiency with Microsoft Power BI, Oracle Cloud Analytics, or other dashboard KPI reporting software.</li>
</ul>
<p><b>Compensation Details</b></p>
<p>
The salary range listed for this role is $145k-$176k/year ($70-$85/hour). The final salary offered will be based on multiple factors and thoughtfully aligned with each candidate's level of experience, breadth of skills, total education achieved, certifications/licenses that have been obtained, geographic location, etc.</p>
<p><b>
Just LOOK at the Benefits We Offer!</b></p>
<ul>
<li>Unlimited flexible time off</li>
<li>Paid holidays</li>
<li>Paid parental leave</li>
<li>Health, dental, and vision insurance</li>
<li>Flexible spending accounts (healthcare and dependent or elder care)</li>
<li>Long-term disability insurance</li>
<li>Short-term disability insurance</li>
<li>Life insurance and accidental death and dismemberment</li>
<li>401(k) plan with guaranteed employer contribution</li>
<li>Formal career planning and development program</li>
<li>$2,500 annually toward professional development</li>
<li>Wellness program with monthly wellness stipend</li>
<li>Company cell phone or cell phone plan reimbursement</li>
<li>Free personalized meal planning and nutrition support with a registered dietitian</li>
<li>Free personal financial planning services</li>
<li>Employee assistance program</li>
<li>Employee discounts</li>
<li>Employee referral bonus</li>
</ul>
<p>Specific plan details and coverage for each benefit noted above will be provided upon offer. <i>#IN-LNJS</i></p><div><p>
Luster is committed to creating an inclusive work environment with a diverse workforce. All qualified applicants will receive consideration for employment without regard to criminal history, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. This employer participates in E-Verify. The employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS) with information from each new employee's I-9 to confirm work authorization.</p>
<p>
All positions may be subject to a background check and drug test once a conditional offer of employment is made for any convictions directly related to its duties and responsibilities, in accordance with all applicable local, state, and/or federal regulations.</p>
<p>
This job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.</p>
<p>
Luster does not accept unsolicited resumes. In the absence of a signed agreement, Luster will not consider or agree to payment of any kind. Any unsolicited resumes presented to Luster personnel, including those submitted to Luster hiring managers, are deemed to be the property of Luster.</p>
<p>
Please email hiring@luster.com for accommodations necessary to complete the application process.</p></div></div>

Claims and Change Specialist

Lockton Companies

Complex Claims Specialist

Behavioral Health Group

<p></p><div><p>The key responsibilities of the Payment Posting &ndash; Reconciliation Specialist include but not limited to:</p>
<p><b>
Duties and Responsibilities</b></p>
<ul>
<li>Ensure prompt and regular attendance, meeting BHG attendance standards.</li>
<li>Accurately process manual and electronic remittance advice (ERA) payments and adjustments.</li>
<li>Balance all daily deposits across centers, ensuring cash reports are up to date.</li>
<li>Collaborate with the accounting department on bank reconciliations, cash tracking, and cash management operations.</li>
<li>Interpret and resolve payment issues through extensive primary and secondary research, including locating missing EOBs and insurance payments.</li>
<li>Work across multiple systems to post and reconcile insurance payments accurately.</li>
<li>Investigate and resolve any discrepancies related to deposits or payment postings.</li>
<li>Communicate pertinent information to team members and management as needed.</li>
<li>Prepare daily and monthly cash reports and identify underpayments, overpayments, or credits for resolution.</li>
<li>Retrieve missing payment information from payers via various channels (phone, portals, clearinghouses).</li>
<li>Review account debits and credits, taking necessary action to address any issues.</li>
<li>Perform other duties as assigned by the supervisor.</li>
</ul>
<p><b>Regulatory</b></p>
<ul>
<li>Responsible for complying with all federal, state and local regulatory agency requirements</li>
<li>Responsible for complying with all accrediting agencies</li>
</ul>
<p><b>Marketing and Outreach</b></p>
<ul>
<li>Participate in community and public relations activities as assigned.</li>
</ul>
<p><b>Professional Development</b></p>
<ul>
<li>Responsible for the achievement of assigned specific annual goals and objectives</li>
<li>Demonstrates the belief that addiction is a brain disease, not a moral failing</li>
<li>Demonstrates hope, respect, and caring in all interactions with patients and fellow Team Members</li>
<li>Establishes and maintains positive relationships in the workplace</li>
<li>Can work independently and under pressure while handling multiple tasks simultaneously</li>
<li>Makes decisions and uses good judgment with confidential and sensitive issues</li>
<li>Deals appropriately with others in stressful or other undesirable situations</li></ul><br>
<p></p>
<p><b>
Training</b></p>
<ul>
<li>Participate in and provide in-service trainings as required by federal, state, local, and accrediting agencies</li>
<li>Attend conferences, meetings and training programs as directed</li>
<li>Participate in and/or schedule and attend regular in-service trainings</li>
</ul>
<p><b>Other</b></p>
<ul>
<li>Demonstrated commitment to valuing diversity and contributing to an inclusive working and learning environment</li>
</ul>
<p><b>Minimum Requirements
</b></p><p>The ideal candidate must hold and maintain a valid driver&rsquo;s license. Experience and understanding of chemical addiction is preferable. In addition to meeting the qualifications, the ideal candidate will embody the following characteristics and possess the knowledge, skills and abilities listed below:</p>
<p><b>
Qualifications</b></p>
<p>
The Payment Posting &amp; Reconciliation Specialist must have the following qualifications.</p>
<ul>
<li>At least 3 years of experience in medical payment posting and reconciliation.</li>
<li>Working knowledge of Medicare, Medicaid, Managed Care, and Commercial Insurance plans preferred</li>
<li>Advanced reconciliation and analytical skills specific to medical billing processes.</li>
<li>Proficiency in Excel</li>
<li>Familiarity with clinical terminology, ICD-10, and CPT codes.</li>
<li>Ability to read and interpret Explanation of Benefits (EOBs), HCFA regulations, and HIPAA compliance requirements.</li>
<li>Proficiency in 10-key touch and keyboarding skills.</li>
<li>Excellent verbal and written communication skills.</li>
<li>Strong interpersonal skills and the ability to foster teamwork.</li>
<li>Superior attention to detail and organizational abilities.</li>
<li>Proficiency with Microsoft Office Suite or related software.</li>
</ul>
<p><b>Physical Requirements and Working Conditions
</b></p><p>The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.</p>
<ul>
<li>Communicate effectively by phone or in person.</li>
<li>Vision adequate to read correspondence and computer screens.</li>
<li>Prolonged sitting, some bending, stooping, and stretching.</li>
<li>Manual dexterity for operating office equipment.</li>
<li>Variable workload and periodic high stress.</li>
<li>Standard medical office environment.</li>
<li>Interaction with patients with various health and legal issues.</li>
<li>Extended keyboarding periods.</li>
</ul>
<p><b>Disclaimer
</b></p><p>The above statements are intended to describe the general nature and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of team members so classified. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed, and this job description may be updated at any time.</p>
<p><i>
BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.</i></p><p></p><p>
Equal Opportunity Employer<br>
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</p></div>

Medical Payment Posting & Reconciliation Specialist

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