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The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring compliance and enhancing client relationships.

In this job, you will:

+ Maintain ongoing knowledge of program requirements

+ Analyze and process claims for accuracy, eligibility, and benefits coverage

+ Retain and strengthen relationships with clients and members

+ Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary

+ Correspond to verify if the amounts are related to the claim

+ Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems

+ Adhere to quality assurance objectives and goals

+ Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising’s returns from administration services

+ Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments

+ Keep management updated on activities, issues and developments

+ Document all claims decisions and communications with members in the system accurately and timely

+ Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies

+ Special projects as assigned by management

Reports to: Program Manager

Requirements

Education/Training

+ High school diploma required; Associate’s or Bachelor’s degree preferred

+ CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred

Experience

+ 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position(s)

Skills/Competencies

+ Knowledge of Group Health Insurance, Workers' Compensation, No-Fault, and/or Liability industry

+ Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices

+ Well-developed time-management, organization, and prioritization skills

+ Excellent analytical skills

+ Customer-service orientation

+ Excellent oral and written communication skills

+ Knowledge of medical billing procedures

+ Ability to gather data, compile information, and prepare summary reports

+ Strong interpersonal and conflict resolutions skills

+ Ability to work independently and as part of a team a fast-paced, multi-faceted environment

+ Demonstrated persistence and attention to detail

Physical/Mental Demands:

+ Remaining in a seated position

+ Entering text or data into a computer

+ Visual Acuity

+ Talking

+ Hearing

+ Repetitive arm, hand, and finger motions

+ Working remotely some or all of the time

Benefits

+ Pay Range: $24-28.00

+ Health insurance (4 different plans to choose from)

+ Dental

+ Vision

+ Paid time off (PTO) or Flexible Time Off (FTO)

+ 401(k)

+ Basic Life Insurance and Long-Term Disability Insurance (paid by the company)

+ Voluntary Life Insurance and Short-Term Disability Insurance

+ Flexible Spending Accounts (FSA)

+ Employee Assistance Program (EAP)

+ Rise Well Wellness Program

+ Professional Development Reimbursement Program (PDRP)

+ You will be part of our new Elevate program designed to recognize and reward employees for their hard work

About Us:

Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations. At RISING, we’re committed to:

+ Continuous technological improvement

+ Entrepreneurial attitude

+ Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what's really important, and keeping a sense of humor

+ Responding quickly to client needs

+ Being the best, not the biggest