Claims Processing Specialist, Bilingual – Spanish
SafeRide Health
full-time
Posted on:
Location Type: Hybrid
Location: San Antonio • Texas • United States
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Job Level
About the role
- Facilitates data processing and processes claims for NEMT and GMR rides.
- Performs reconciliation of billing data to encounter data.
- Works closely with the operations team to resolve issues.
- Work with internal operations and project teams to solve claims-related problems, benefit plans research and provider contract interpretation and configurations.
- Communicate and work with providers to get claims issues resolved and paid accurately and in accordance with healthcare/Medicare/Medicaid regulations, policies, and payment policies and guidelines.
- Receive incoming calls from providers, customers, vendors, and internal groups, to successfully analyze the caller's needs, research information, answer questions, and resolved issues and/or disputes in a timely and accurate manner.
- Identify issues negatively impacting the provider community including but not limited to system set up, required benefit modifications, EDI logic, provider education, claim examiner errors, and authorization rules.
- Develops and implements policies, processes and procedures that incorporate industry best practices, and reinforces high quality standards within the Billing team.
- Served as the Billing team’s subject matter expert and primary contact for claims related projects and critical activities.
- Mentors junior team members and provides internal claims team training, coaching, guidance, and assistance with complex issues.
- Implement: Scalable and accurate billing operations systems leveraging best in class technology. This includes financial reporting for management, clients and designated state and federal agencies (e.g., HHSC in Texas).
- Champion and reinforce SafeRide’s culture.
Requirements
- Minimum 1 years of experience in billing/claims management
- Must be bilingual Spanish Speaking
- NEMT/transportation background preferred
- Knowledge of CMS/HHSC regulations preferred
- Strong data skills in Excel/Sheets, including pivot tables, v-lookups, etc.
- Self-starter, ability to work independently and in a team environment.
- Strength in problem solving, applying hard data and qualitative insight to frame problems and develop novel solutions
- Ability to adapt to unforeseen circumstances quickly
- Keen attention to detail
- Ability to work with a variety of stakeholders
Benefits
- An inclusive, encouraging and collaborative company culture
- Strong support for career growth, including access to our investor communities
- Competitive compensation with upside for growth (including stock options and performance grants)
- Competitive benefits including health/vision/dental insurance, 401k match and 18 day ’s PTO
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
billing managementclaims processingdata reconciliationExcelpivot tablesv-lookupsproblem solvingpolicy developmentprovider contract interpretationfinancial reporting
Soft Skills
bilingualself-starterindependent workteam collaborationadaptabilityattention to detailmentoringcommunicationcoachingstakeholder engagement