Claims Specialist

As a Claims Specialist you are the engine behind our financial health. Youll be navigating the complexities of the healthcare reimbursement cycle to ensure accuracy transparency and efficiency. You will act as a vital bridge between our clinics and insurance payers ensuring that the care our patients receive is reflected accurately in our billing. This role is based in Flower Mound TX and will work very closely with multiple departments to ensure strong communication among the various stakeholders.

JOB SPECIFIC FUNCTIONS:

• Revenue Lifecycle Management: Own the end-to-end claims process including collecting posting and managing patient payments with high precision.

• Claim Integrity: Meticulously verify visit detailsincluding time location and insurance authorizationto minimize denials before they happen.

• Strategic Payer Follow-up: Proactively track remits and engage with insurance payers to resolve outstanding issues and ensure timely reimbursement.

• Cross-Functional Collaboration: Partner closely with clinic staff and internal departments to clarify billing entries and provide updates on ongoing claim developments.

• Compliance & Accuracy: Ensure all claims utilize correct billing information (providers modifiers and clinic locations) before final submission.

• Queue Management: Efficiently filter and manage daily patient billing lists by clinic and date.

• Authorization Oversight: Maintain a Hold protocol for temporary authorizations or insurance transitions to protect revenue integrity.

• Quality Control: Audit claims for appropriate modifiers and correct billing data points prior to transmission.

Qualifications :

• Education: HS Diploma required; Degree in progress or completed preferred.

• Experience: 2 years of Medical Billing/RCM experience (preferred).

• Skills:

  • Deep understanding of medical billing/coding and EPM systems.

  • Proficiency in office technology and multi-line phone management.

  • Exceptional organizational skills with high attention to detail.

  • Strong interpersonal skills for effective team and patient communication.

Additional Information :

Starting Hourly Rate: $19 - $22 per hour

Status: Full time non-exempt

Remote Work :

No

Employment Type :

Full-time