Quadrant Health Group
Join our talented team at
Quadrant Health Group ! Quadrant Billing Solutions, a distinguished member of the Quadrant Health Group, is eager to welcome a dedicated and enthusiastic Claims Specialist to our expanding team. In this role, you will be crucial in ensuring efficient and effective delivery of healthcare services. Why Choose Quadrant Health Group? Attractive salary based on experience. Comprehensive benefits package, including medical, dental, and vision insurance. Generous paid time off, sick leave, and holidays. Opportunities for professional development and career advancement. A supportive, collaborative work environment. The chance to make a tangible impact on our clients' lives. Compensation:
$18 - $24 per hour - Full-time Your Responsibilities: We are looking for a candidate who is organized, persistent, and results-driven, with an in-depth understanding of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You'll be part of a high-performance team dedicated to maximizing collections, minimizing Aging Accounts Receivable (A/R), and ensuring every dollar is accounted for. Key Responsibilities Include: Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care. Manage 500-700 claims weekly with an emphasis on efficiency and accuracy. Engage in 45 hours of phone time daily while demonstrating strong communication capabilities. Collaborate with payers through phone, online portals, and written correspondence to resolve billing challenges. Identify denial trends and underpayment issues, escalating systemic problems as needed. Dispute and overturn incorrectly denied claims. Track and update claims using CMD (CollaborateMD) and internal systems. Follow QBS workflows utilizing Google Drive, Docs, Sheets, and Kipu EMR. Maintain timely and professional communication with internal teams and facility partners. Bonus Experience (Preferred): Managing refund requests and appeals. Preparing and submitting level 13 appeals (e.g., medical necessity, low pay, timely filing). Gathering and submitting medical records for appeal support. Experience with utilization review (UR) processes or collaborating with clinical teams. Familiarity with ASAM and MCG medical necessity criteria. Exposure to payment posting, authorization reviews, or credentialing. Qualifications: A minimum of 1 year of SUD/MH billing and claims follow-up experience is required. High School Diploma or equivalent; an associate or bachelor's degree is preferred. Strong understanding of insurance verification, Explanation of Benefits (EOBs), and Revenue Cycle Management (RCM) workflows. Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest. Experience in overturning insurance denials is highly valued. Proficiency in CMD (CollaborateMD) and Kipu EMR is strongly preferred. Excellent written and verbal communication skills are essential. Highly organized, detail-oriented, and able to manage multiple responsibilities effectively. Why Join Quadrant Billing Solutions? Rapid career growth within a mission-driven, specialized billing company. Collaborate with clinical and billing experts familiar with behavioral health. Become part of a close-knit, supportive team culture. Access opportunities for leadership advancement as the company evolves. #HP
Quadrant Health Group ! Quadrant Billing Solutions, a distinguished member of the Quadrant Health Group, is eager to welcome a dedicated and enthusiastic Claims Specialist to our expanding team. In this role, you will be crucial in ensuring efficient and effective delivery of healthcare services. Why Choose Quadrant Health Group? Attractive salary based on experience. Comprehensive benefits package, including medical, dental, and vision insurance. Generous paid time off, sick leave, and holidays. Opportunities for professional development and career advancement. A supportive, collaborative work environment. The chance to make a tangible impact on our clients' lives. Compensation:
$18 - $24 per hour - Full-time Your Responsibilities: We are looking for a candidate who is organized, persistent, and results-driven, with an in-depth understanding of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You'll be part of a high-performance team dedicated to maximizing collections, minimizing Aging Accounts Receivable (A/R), and ensuring every dollar is accounted for. Key Responsibilities Include: Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care. Manage 500-700 claims weekly with an emphasis on efficiency and accuracy. Engage in 45 hours of phone time daily while demonstrating strong communication capabilities. Collaborate with payers through phone, online portals, and written correspondence to resolve billing challenges. Identify denial trends and underpayment issues, escalating systemic problems as needed. Dispute and overturn incorrectly denied claims. Track and update claims using CMD (CollaborateMD) and internal systems. Follow QBS workflows utilizing Google Drive, Docs, Sheets, and Kipu EMR. Maintain timely and professional communication with internal teams and facility partners. Bonus Experience (Preferred): Managing refund requests and appeals. Preparing and submitting level 13 appeals (e.g., medical necessity, low pay, timely filing). Gathering and submitting medical records for appeal support. Experience with utilization review (UR) processes or collaborating with clinical teams. Familiarity with ASAM and MCG medical necessity criteria. Exposure to payment posting, authorization reviews, or credentialing. Qualifications: A minimum of 1 year of SUD/MH billing and claims follow-up experience is required. High School Diploma or equivalent; an associate or bachelor's degree is preferred. Strong understanding of insurance verification, Explanation of Benefits (EOBs), and Revenue Cycle Management (RCM) workflows. Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest. Experience in overturning insurance denials is highly valued. Proficiency in CMD (CollaborateMD) and Kipu EMR is strongly preferred. Excellent written and verbal communication skills are essential. Highly organized, detail-oriented, and able to manage multiple responsibilities effectively. Why Join Quadrant Billing Solutions? Rapid career growth within a mission-driven, specialized billing company. Collaborate with clinical and billing experts familiar with behavioral health. Become part of a close-knit, supportive team culture. Access opportunities for leadership advancement as the company evolves. #HP