Claims Operations Specialist

📋 Description

• Review insurance claims daily for accuracy and compliance.
• Follow up on outstanding accounts receivable across payer types.
• Enter and maintain claim data in the EHR; manual claims when needed.
• Support payer enrollment, tracking progress and coordination with payers.
• Maintain payer enrollment and credentialing records.
• Assist chart reviews for HEDIS and risk adjustment; cross-functional tasks.

🎯 Requirements

• CPT/ICD basics and full claims lifecycle knowledge.
• 5+ years in medical billing or revenue cycle ops.
• Experience with payers on claim follow-up and denial resolution.
• Athena or other EMR/EHR experience required.
• Strong organizational skills and deadline management.
• Clear communication and high accountability.