Jobgether
Accountabilities:: Review internal data and payer correspondence to determine the correct order of benefits and resolve Coordination of Benefits and Third Party Liability issues. Investigate complex eligibility discrepancies, claims issues, payment discrepancies, and other records requiring detailed research. Communicate with healthcare insurance carriers to determine primacy, resolve questions, and facilitate appropriate payment or account action. Analyze and interpret 277 claim rejections, Explanation of Benefits, and other payer communications. Research eligibility scenarios, claims appeals, and other issues to achieve successful resolution and payment. Take appropriate action based on payer requirements and maintain clear, accurate documentation in internal systems. Update account records with payer contacts, demographic information, communication notes, outreach attempts, and account status. Work assigned inventories efficiently while consistently meeting or exceeding established productivity and quality targets. Collaborate with internal teams to identify opportunities for improving claims billing, denial management, workflows, and systems. Contribute to the development of scripts, guidelines, training materials, and other tools supporting professional communication with healthcare carriers and providers. Support management with inventory assessment and distribution across team members. Provide feedback to management and analytics teams to improve products, services, workflows, and documentation. Assist with new client program launches, client requests, reporting, reconciliations, testing, data analysis, and analytics reviews. Lead or contribute to ad hoc projects, operational initiatives, and the establishment of best practices. Apply policies, procedures, training, HIPAA requirements, client requirements, and applicable regulations consistently. Support junior team members through knowledge sharing, instructional guidance, and subject matter expertise. Requirements: High school diploma or GED required; college education preferred, or an equivalent combination of education and relevant experience. At least 4 years of progressively relevant experience in billing reclamation, healthcare recovery, denial management, Coordination of Benefits, Third Party Liability, or related functions. At least 1 year of experience contributing to operational initiatives involving workflow improvement, reporting and data analysis, new client or program setup, subject matter expertise, training, or staff oversight. Strong knowledge of healthcare operations, medical terminology, and medical coding. Substantial expertise in Coordination of Benefits, Third Party Liability, accounts receivable, and healthcare reclamation. Proven ability to interpret 277 rejections and Explanation of Benefits and use that information to resolve both standard and complex payment issues. Strong investigative, critical-thinking, analytical, and problem-solving abilities with a high degree of accuracy. Excellent professional communication skills and the ability to build positive relationships with healthcare carriers, clients, providers, and internal teams. Ability to handle sensitive information appropriately and consistently follow HIPAA standards and applicable regulations. Intermediate to advanced Microsoft Excel skills, including the ability to analyze large datasets. Strong proficiency with computers, standard office applications, online tools, and communication technology. Ability to work independently while contributing effectively to a collaborative team environment. Ability to serve as a subject matter expert, lead by example, and support the development of junior team members. Strong organizational skills, attention to detail, adaptability, and ability to manage multiple priorities in a fast-paced environment. Ability to quickly adjust to changing assignments, processes, programs, and business requirements. Ability to obtain and maintain required client clearances and successfully complete applicable background and screening requirements. Ability to work legally in the United States. Benefits: $52,000–$58,000 annual salary, depending on experience, skills, certifications, and other relevant factors. Fully remote work from anywhere in the United States. Medical, dental, and vision insurance. Flexible Spending Account and Health Savings Account options. Tuition reimbursement. 401(k) with company matching. Additional health and wellness benefits and perks. Flexible and trusting work environment that supports employee autonomy. Opportunities to contribute to operational improvements and new client programs. Professional development and opportunities to apply healthcare reclamation expertise at a senior level. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1