Claims Resolution Specialist

Location: Bloomfield Hills, MI

Department: Claims

Type: Full Time

Min. Experience: Student (College)

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 (www.accessintegra.com) 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 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 inventor
  • 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

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%

EMPLOYEE BENEFITS

  • Competitive compensation with bonus opportunity
  • 401(k) eligibility
  • Medical, Vision, Dental Benefits
  • Standard business hours, Monday – Friday
  • Paid Time Off (PTO); able to start using acquired time 90 days after hire
  • Collaborative and engaging office environment
  • Opportunity to be a key member of a rapidly growing company
  • Company sponsored events (holiday parties, sporting events, team building activities)
  • Company and department specific trainings

 

It is the policy of Integra Partners to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Integra Partners will provide reasonable accommodations for qualified individuals with disabilities.

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