Job Description
About Us
Our culture is based on connection, and that fuels our outstanding performance. At BroadPath, we maintain and nourish a commitment to home-based talent and innovative workforce technology that enables us to deliver unrivaled quality, flexibility, and transparency. We believe in meeting our associates where they are, be it in geography or career development. Our proprietary platform visually connects the members of each home-based client team, fully unleashing the skills and motivation of the industry’s best workforce and enabling our associates to reach their full potential. BroadPath is where connection happens.
Today, we provide services to Fortune 10 Health plan companies and Healthcare providers. BroadPath essential business functions include customer experience, sales, and back-office operations.
Overview
Broadpath is immediately hiring for a Claims Processor to join our team. Our Claims Processor will be responsible for accurately and timely entering, reviewing, and resolving simple to moderate-complexity claims according to the guidelines, procedures, and policies.
Responsibilities
Conduct thorough reviews of claim denials and incorrect payments, with a focus on identifying opportunities for appeal. This involves utilizing various guidelines and reference tools such as CPT, ICD-9, ICD-10, HCPCS, medical terminology manuals, Correct Coding Initiative Edits, Medicare Fee Schedule, and modifier rules.
Demonstrate proficiency in investigating rules and processes related to claims where necessary, ensuring adherence to industry standards and regulations.
Ability to process both clean and unclean claims efficiently, maintaining accuracy and compliance with payer requirements.
Utilize electronic claim editing systems to verify the accuracy and completeness of all necessary information before submission to payers.
Post insurance and patient payments accurately, applying correct denial codes to facilitate proper account management.
Engage with physician offices to gather additional information required to address claim edits or pursue appeals for denied claims.
Effectively manage and resolve correspondence from insurance companies and patients, demonstrating strong communication skills.
Retrieve all necessary information to assess the validity of refund requests and take appropriate action.
Participate in the mailing process of patient statements, ensuring timely and accurate communication with patients regarding their accounts.
Qualifications
Proficiency in handling daily computer operations with ease, showcasing strong technical skills.
Previous experience in navigating health insurance claims processes, preferably on either the payer or provider side.
Solid understanding of medical and insurance billing practices, demonstrating knowledge in this area.
Exceptional communication abilities coupled with outstanding customer service skills.
Adeptness in identifying the root causes of unpaid claims or patient accounts and devising efficient communication strategies and methods for appeals, along with providing accurate documentation for resolution.
Familiarity with payer and governmental regulations governing the revenue cycle process, ensuring compliance with rules and regulations.
Effective communication skills for liaising with physicians and practice staff to gather additional information for resolving edits and unpaid claims.
Ability to engage with patients, effectively communicating about their accounts and addressing any queries or concerns they may have.
Systems Experience Required:
IDC 10 Code knowledge is required. ( ICD Code 9 knowledge is also acceptable)
Preferred Qualification:
1-2 years of claims processing experience
Experience in Adjustments, Adjudication, and Provider Dispute Resolution ( PDR) is highly valued as it showcases a deep understanding of the claims process.
Epic Tapestry is highly preferred.
Diversity Statement
At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!
Equal Employment Opportunity/Disability/Veterans
If you need accommodation due to a disability, please email us at [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process
BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.
Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
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