Integra Partners
JOB OVERVIEW
Our Claims Resolution Specialist role is responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy while maintaining appropriate documentation and account records, as well as timely issue resolution. In this role, you will ensure work is in compliance with all legal, regulatory, and internal Integra policies and procedures, including HIPAA compliance. If you have previous medical billing or claims experience, this role may be of interest as a next step in your career.
JOB RESPONSIBILITIES
Accountable for daily productivity goals at or above the current production metric
Maintain a climate of teamwork and collaborative problem solving
Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectives
Stay informed on product information, changes in Medicare/State/Contract funding procedures, and updates in policies and procedures
Contribute beyond fundamental responsibilities to support company growth and department development
Adds value and positive contributions towards the company and department culture
Understand and perform duties in compliance with State and Federal regulations and the policies and procedures of Integra
Achieve and maintain an individual effectiveness rate of 70% +
Contributes to the department maintaining AR aging over 120 days at 10% or less of total inventory
Strong Microsoft Office skills (Excel in particular) and ability to learn new programs and software
Must type 45+ words per minute
Familiar with ICD-10, HCPCS, and medical terminology
Ability to follow verbal and written instructions
Ability to maintain consistent, regular attendance and punctuality
Performs miscellaneous duties as assigned
WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
In the first 6 months you will learn Integra’s claims platform (QUE) and how to navigate it thoroughly (i.e. transmit new claims to payers, submit corrected claims, update member information, adjust off correctly adjudicated claims, etc.).
You will learn your job role and responsibilities and which tools/references are available to you to assist in resolving unpaid claims.
You will build your knowledge base in relation to the insurance plans one plan at a time, so that in 6 months you are the subject matter expert on those plans and are able to spot any payer issue trends.
During this time you will set measurable goals for personal development and growth.
WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?
You will be fully integrated with your job, company and team.
You will continue to learn additional insurance plans and become a subject matter expert on multiple plans.
You will contribute your skills and knowledge to meet your department’s metrics and goals.
You will have regular monthly one-on-one meetings with leaders for mutual feedback and have initiated your personal development plan so you have started to define a path for growth.
COMPENSATION:
$19.00/hour
EXPERIENCE:
Familiarity with the 1500 claim forms, and DMEPOS services
Knowledge of ICD-10, HCPCS, and medical terminology
Understanding of CMS guidelines, and Medical Policy adopted by the plan
Correctly read and assess medical documents
Must type 45+ words per minute
Computer experience, and the ability to learn new programs and software, Microsoft Word and Microsoft Excel background is a necessity
Conduct yourself in a courteous, helpful, and professional manner at all times
Passion for your work and the mission of the company
Motivated and able to work independently within a fast-paced, team environment
Must be organized and thorough
Sound judgement and critical thinking
Ability to work overtime as required
Must follow policies regarding attendance and punctuality
Meet all daily productivity and weekly quality goals
Benefits Offered
Competitive compensation and annual bonus program
401(k) retirement program with company match
Company-paid life insurance
Company-paid short term disability coverage (location restrictions may apply)
Medical, Vision, and Dental benefits
Paid Time Off (PTO)
Paid Parental Leave
Sick Time
Paid company holidays and floating holidays
Quarterly company-sponsored events
Health and wellness programs
Career development opportunities
Remote Opportunities We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in‑home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
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JOB RESPONSIBILITIES
Accountable for daily productivity goals at or above the current production metric
Maintain a climate of teamwork and collaborative problem solving
Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectives
Stay informed on product information, changes in Medicare/State/Contract funding procedures, and updates in policies and procedures
Contribute beyond fundamental responsibilities to support company growth and department development
Adds value and positive contributions towards the company and department culture
Understand and perform duties in compliance with State and Federal regulations and the policies and procedures of Integra
Achieve and maintain an individual effectiveness rate of 70% +
Contributes to the department maintaining AR aging over 120 days at 10% or less of total inventory
Strong Microsoft Office skills (Excel in particular) and ability to learn new programs and software
Must type 45+ words per minute
Familiar with ICD-10, HCPCS, and medical terminology
Ability to follow verbal and written instructions
Ability to maintain consistent, regular attendance and punctuality
Performs miscellaneous duties as assigned
WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
In the first 6 months you will learn Integra’s claims platform (QUE) and how to navigate it thoroughly (i.e. transmit new claims to payers, submit corrected claims, update member information, adjust off correctly adjudicated claims, etc.).
You will learn your job role and responsibilities and which tools/references are available to you to assist in resolving unpaid claims.
You will build your knowledge base in relation to the insurance plans one plan at a time, so that in 6 months you are the subject matter expert on those plans and are able to spot any payer issue trends.
During this time you will set measurable goals for personal development and growth.
WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?
You will be fully integrated with your job, company and team.
You will continue to learn additional insurance plans and become a subject matter expert on multiple plans.
You will contribute your skills and knowledge to meet your department’s metrics and goals.
You will have regular monthly one-on-one meetings with leaders for mutual feedback and have initiated your personal development plan so you have started to define a path for growth.
COMPENSATION:
$19.00/hour
EXPERIENCE:
Familiarity with the 1500 claim forms, and DMEPOS services
Knowledge of ICD-10, HCPCS, and medical terminology
Understanding of CMS guidelines, and Medical Policy adopted by the plan
Correctly read and assess medical documents
Must type 45+ words per minute
Computer experience, and the ability to learn new programs and software, Microsoft Word and Microsoft Excel background is a necessity
Conduct yourself in a courteous, helpful, and professional manner at all times
Passion for your work and the mission of the company
Motivated and able to work independently within a fast-paced, team environment
Must be organized and thorough
Sound judgement and critical thinking
Ability to work overtime as required
Must follow policies regarding attendance and punctuality
Meet all daily productivity and weekly quality goals
Benefits Offered
Competitive compensation and annual bonus program
401(k) retirement program with company match
Company-paid life insurance
Company-paid short term disability coverage (location restrictions may apply)
Medical, Vision, and Dental benefits
Paid Time Off (PTO)
Paid Parental Leave
Sick Time
Paid company holidays and floating holidays
Quarterly company-sponsored events
Health and wellness programs
Career development opportunities
Remote Opportunities We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in‑home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
#J-18808-Ljbffr