Senior Claims Specialist
Integrated Specialty Coverages, LLCSalary not specified
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- 3+ years experience in revenue cycle support role
- Proficiency in using medical billing software and EHR systems
- Proficient in Microsoft Excel and/or Google Sheets
- Independent, critical thinker with meticulous attention to detail
- Demonstrate proficiency in navigating multiple systems and workflows while maintaining adaptability in a rapidly changing environment
Responsibilities
- Reviewing and submitting claims within payor guidelines to ensure timely and accurate filing
- Reporting on aging encounters, and partnering with clinicians to resolve them, ensuring compliance with internal best practices
- Resolving and appealing claims denials, and working with the Revenue Cycle Manager to improve workflows and optimize our claim submission process
- Reconciling ERAs by resolving holds, manually posting payments and adjudicating claims
- Collaborating with other teams to identify and update missing patient demographic and insurance data
- Proactively identifying opportunities and implementing processes to optimize efficiency and accuracy within the billing function
- Collaborating effectively within a team-oriented environment and demonstrating a proactive approach to managing small projects across various functions
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What experience is required for the Revenue Cycle Specialist role?
Candidates need 3+ years of experience in a revenue cycle support role, along with proficiency in medical billing software, EHR systems, and Microsoft Excel or Google Sheets.
What does the company culture at Pomelo Care look like?
Pomelo Care fosters a team-oriented environment that values collaboration across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first, while respecting employees from all backgrounds.
Is this a remote position at Pomelo Care?
This information is not specified in the job description.
What is the salary or compensation for this role?
This information is not specified in the job description.
What makes a strong candidate for this Revenue Cycle Specialist position?
Strong candidates are independent critical thinkers with meticulous attention to detail, proficiency in navigating multiple systems, and adaptability in a rapidly changing environment, plus the required experience in revenue cycle support.
Pomelo Care
Personalized healthcare for pregnancy and newborns
About Pomelo Care
Pomelo Care provides personalized healthcare services for pregnant individuals and newborns. The company combines traditional medical practices with advanced technology to improve health outcomes for families. Their services are designed to be accessible and focus on evidence-based care, ensuring that expectant mothers and their newborns receive the best possible support. Unlike many competitors, Pomelo Care emphasizes a tailored approach to healthcare, integrating technology to enhance the patient experience. The goal of Pomelo Care is to create a supportive environment that promotes the health and well-being of families during pregnancy and early childhood.
New York City, New YorkHeadquarters
2021Year Founded
$84.6MTotal Funding
SERIES_BCompany Stage
HealthcareIndustries
11-50Employees
Benefits
Health Insurance
Company Equity
Paid Vacation
Risks
Competition from similar maternity care providers may reduce Pomelo's market share.
Operational challenges from integrating The Doula Network could affect service delivery.
Regulatory scrutiny on virtual healthcare may increase compliance costs for Pomelo.
Differentiation
Pomelo Care combines virtual and in-person maternity services, unique in the industry.
The acquisition of The Doula Network enhances Pomelo's comprehensive care model.
Pomelo uses data science to improve maternal and infant health outcomes.
Upsides
Increased demand for telehealth boosts Pomelo's virtual care services.
Expansion of Medicaid coverage offers Pomelo new market opportunities.
Growing interest in personalized healthcare aligns with Pomelo's service model.
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