Claims Inquiry Representative - $19.00 per hour
6 - 10 years
New York City Metropolitan Area
Full-time
Remote
1 month ago
About the role
About the Role
This opportunity is for a detail-oriented Claims Inquiry Representative responsible for responding to provider and health plan partner inquiries, reviewing Durable Medical Equipment (DME) claims for billing accuracy, investigating claim-related issues, and delivering professional and timely resolutions.
This role requires strong analytical skills, medical billing knowledge, attention to detail, and the ability to maintain compliance with HIPAA and all applicable state and federal regulations.
The position also requires maintaining documentation accuracy, collaborating with internal teams, adapting to changing priorities, and consistently meeting productivity expectations in a fast-paced remote environment.
What You’ll Do
Qualifications
Benefits
Eligible Work Locations
New York , New Jersey , Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
This opportunity is for a detail-oriented Claims Inquiry Representative responsible for responding to provider and health plan partner inquiries, reviewing Durable Medical Equipment (DME) claims for billing accuracy, investigating claim-related issues, and delivering professional and timely resolutions.
This role requires strong analytical skills, medical billing knowledge, attention to detail, and the ability to maintain compliance with HIPAA and all applicable state and federal regulations.
The position also requires maintaining documentation accuracy, collaborating with internal teams, adapting to changing priorities, and consistently meeting productivity expectations in a fast-paced remote environment.
What You’ll Do
- Respond to provider and plan partner inquiries through webforms in a professional and timely manner
- Review DME claims to ensure billing accuracy and compliance standards are met
- Investigate root causes of claim-related issues and identify appropriate resolutions
- Maintain accurate documentation and records related to inquiries and claim reviews
- Work effectively with multiple health plan payers and adapt to changing assignments
- Support team goals and organizational initiatives through additional assigned duties
- Collaborate with team members to promote effective problem-solving and teamwork
- Maintain productivity metrics that meet or exceed departmental standards
- Follow written and verbal instructions accurately and consistently
- Ensure all work complies with HIPAA guidelines, company policies, and state and federal regulations
- Independently research issues and utilize available resources to resolve problems efficiently
- Maintain a high level of attention to detail to ensure quality and accuracy
- Demonstrate flexibility and adaptability in a changing work environment
- Maintain dependable attendance and punctuality standards
- Contribute positively to team culture and departmental success
Qualifications
- High school diploma required
- Previous medical billing experience required
- Knowledge of 1500 claim forms, DMEPOS services, ICD-10 coding, HCPCS codes, and medical terminology
- Ability to accurately review medical documentation and claims information
- Proficiency with Microsoft Office including Word, Excel, and Outlook
- Ability to quickly learn new systems and software programs
- Strong organizational, analytical, and critical thinking skills
- Self-motivated with the ability to work independently in a remote environment
- Ability to work effectively in a fast-paced team setting
- Strong communication and problem-solving abilities
- Reliable work ethic and consistent attendance record
- Ability to maintain a minimum internet download speed of 200 Mbps for remote work requirements
Benefits
- Competitive compensation package
- Annual bonus program
- 401(k) retirement plan with company match
- Company-paid life insurance
- Company-paid short-term disability coverage where applicable
- Medical, dental, and vision insurance
- Paid Time Off (PTO)
- Paid parental leave
- Sick time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development and advancement opportunities
- Remote work opportunities
Eligible Work Locations
New York , New Jersey , Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.