New York, New york
Claims Resolution Specialist Job Opening in New York, New york - The Company
Integra Partners is a leading, tech-enabled, healthcare benefit management company focused on community-based care. Integra has a core competency in Durable Medical Equipment (DME), Orthotics and Prosthetics (O&P), and works with providers and health plans to facilitate care for hundreds of thousands of patients each year. We have experienced rapid growth with no slowdown in sight.
Our leadership team is amazing () and focused on what really matters to our business - every employee, every experience, and every customer. With the right people, success is unbounded. This is a truly unique opportunity to take a position with a great company, surrounded by an awesome team.
In 2015, Integra?s management and Tufts Health Plan of Massachusetts acquired the business. Tufts Health Plan is one of the country?s leading, 5-star, private health plans providing healthcare to individuals and employer groups. Integra now operates as a separate financial investment and subsidiary of Tufts Health Plan with a separate board of directors and governance structure. Integra is an innovative and exciting company, with an entrepreneurial culture focused on teamwork and everyday excellence.
Scope and Responsibility
Responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy, while maintaining appropriate documentation and account records, as well as timely issue resolution. Ensure all work is in compliance with all legal, regulatory, and internal Integra policies and procedures, as applicable (including, but not limited to HIPAA compliance) at all times.
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 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
Key Expected Accomplishments
Maintain current on all claim rejections, denials, and inquiries by assigned payors.
Achieve an effectiveness rate of 70% +
Key Metrics and Goals
AR over 120 days under 10%
Meet all daily productivity and weekly quality goals
ER over 70%
Job Type: Full-time
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