Claims Submission Specialist

RAYUS now offers DailyPay! Work today, get paid today!

The pay range for this position is $20.70 -$29.93 based on direct and relevant experience.

RAYUS Radiology is looking for a Claims Submission Specialist to join our team. We are challenging the status quo by shining light on radiology and making it a critical first step in diagnosis and proper treatment. Come join us and shine brighter together! As a Claims Submission Specialist, you will be responsible for identifying and resolving medical claim related issues (pre-claim submission), monitoring billing rejections and maintaining accurate insurance records. This role prevents claims errors, minimizes denials and supports accurate claim submissions by proactively correcting insurance information before the date of service.The Claims Submission Specialist is a member of the Revenue Cycle Management (RCM) Department that manages billing exceptions, payer maintenance, eligibility-related updates, and pre-service insurance reviews to improve claim accuracy, reduce denials and support timely reimbursement. This is a remote Full time position working Monday- Friday, working corporate day shift.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

(95%) Claims Duties

1. Review pre-service validation (PSV) reports generated through system edits, audit upcoming appointments to verify authorizations, member IDs, group numbers and payer assignments based on service locations
2. Contribute to the reduction of days sales outstanding (DSO), increase monthly gross collections and support overall improvement in collection percentages
3. Meet or exceed established RCM quality assurance standards, ensuring accuracy, compliance and consistency in all assigned responsibilities
4. Clear Rejections: Review and resolve claim rejections within clearinghouse applications to minimize reimbursement delays; escalate complex billing items to leadership with appropriate notation
5. Verify Eligibility: Validate active member coverage and details before resubmitting modified claims
6. Maintain Payers: Add, update, or terminate insurance payer profiles within company databases to preserve information accuracy
7. Coordinate Coverage: Review and configure coordination of benefits rules within the systems to ensure accurate primary, secondary and tertiary payer ordering
8. Update Variances: Adjust demographic details and name variances on billing records in strict alignment with official insurance payer documentation
9. Research Account Data: Investigate patient chart documentation across all applicable software systems to locate accurate billing data and missing account details
10. Worklist Maintenance: Manage assigned billing worklists and daily queues according to established standard operating procedures
11. Process Pre-Service Reports: Complete daily PSV reports thoroughly, by proactively reviewing upcoming accounts to verify eligibility, authorizations, payer information and other requirements, resolving issues prior to the scheduled service date
12. Identify, monitor and communicate workflow trends, issues and opportunities for improvement to departmental leadership
13. Communicate effectively and timely with patients, insurance carriers, team members, centers, markets and referral sources to facilitate accurate claim submissions and ensure claims are processed successfully by payers
14. Effectively prioritize workload by focusing on high-impact and priority tasks that drive financial performance and support achievement of organizational objectives
15. Actively contribute to a positive, collaborative team environment and support departmental goals through teamwork and shared accountability

Required:

1. High School Diploma, or equivalent
2. Two (2) years' experience in healthcare billing exceptions, claim rejections, insurance denials or revenue cycle workflows
3. Experience in electronic health records, medical billing software and clearinghouse applications
4. Proficient in Microsoft Excel, Word and Outlook

Preferred:

1. Graduate from an accredited medical billing program
2. Experience in Nextgen and Waystar

RAYUS is committed to delivering clinical excellence in communities across the U.S., driven by our passion for and superior service to referring providers and patients. RAYUS Radiology is built on our brilliant medicine, brilliant team, brilliant technology and services - all to provide the highest level of patient care possible.

We bring brilliance to health and wellness. Join our team and shine the light on Radiology Services! RAYUS Radiology is an EO Employer/Vets/Disabled.

We offer benefits (based on eligibility) including medical, dental and vision insurance, 401k with company match, life and disability insurance, tuition reimbursement, adoption assistance, pet insurance, PTO and holiday pay and many more! Visit our career page to see them all www.rayusradiology.com/careers.

DailyPay implementation is contingent upon initial set-up period.