Medical Billing Specialist - Verity Solutions - Remote (Finance)

Verity Solutions - Medical Billing Specialist

Job Description Summary

We are seeking a detail-oriented and experienced Medical Billing Specialist to develop and manage a scalable framework of workflow, process and tactics that support the medical billing lifecycle and and financial reporting. The ideal candidate will have a strong background in revenue cycle management workflow and operational tactics in a healthcare setting, with a focus on maintaining efficient billing processes. This role is crucial for managing customer accounts, billing coding, and ensuring timely payor remittances, all while providing exceptional service to our clients. This role will assist with prior authorizations as needed.

Job Objective

This role oversees revenue cycle management (RCM) processes, including prior authorizations, claim submission, payment processing, and collections. Additionally, implements and supports specific client RCM services defining standardized and best practice workflows and tactics that ensure accuracy and maximize payor remittances and client cashflow.

Duties and Responsibilities:

• Leads the development of standardized RCM workflow, policies and procedures that enable a scalable RCM service solution to multiple clients.
• Routinely engages with clients to manage RCM actions, needs, and business results as the key business partner.
• Assists in tracking and resolving claim rejections for various clients of different size and medical disciplines
• Facilitates communication between health care providers and insurance companies as it relates to medical claim submissions, rejections and payouts, and other needs as defined.
• Provide proactive, timely, and comprehensive updates to clients on current status of claim submissions.
• Identifies operational system enhancement opportunities to automate and scale RCM services. Works with operations leadership and product management to prioritize as appropriate.
• Assist with maintaining department documentation and education tools
• Serve as a professional and courteous face of Verity Solutions through phone, email, webinar or in-person interactions.
• Supports and promotes the Fusebox and Verity Solutions values through positive interactions with both internal and external stakeholders on a regular basis
• Assist with training of new team members
• Attend to other team or cross-departmental initiatives as assigned.

Experience, Skills and Qualifications:

• Certification in medical billing and coding is STRONGLY preferred
• 3+ years as a Medical Biller with strong knowledge of common medical billing practices including but not limited to modifiers and general EMR requirements.
• Ability to read and identify errors in claims prior to claim submission.
• Ability to read and understand common billing forms including but not limited to 837 EDI, CMS-1500, and UB04
• Advanced knowledge of HCPCs, NDC, CPT and ICD-10 codes
• Ability to have flexibility in dealing with workday emergencies and attend to critical client issues.
• Demonstrate ability to maintain professional demeanor and confidentiality
• Proven ability to use critical thinking and problem-solving skills to analyze and troubleshoot problems with customer claims
• Background in Allergy and/or Immunology billing is highly preferred.
• Knowledge of billing requirements for various medical fields required.
• Proven display of interest in customer and colleague success through sharing of knowledge, ideas, tips and experiences.
• Proven ability to communicate verbally and in written form at a high level.
• Able to prioritize tasks and accept working in a fast-paced environment without getting overwhelmed
• Ability to multitask and manage multiple discreet claim submissions at the same time.
• Visible enthusiasm for on-going learning
• Role models a passion for working with customers, proactive problem-solving and troubleshooting, and embodying a culture to exceed expectations.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 21 - 32 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.