The Direct Carrier Billing Specialist is an integral part of the Carrier-to-Carrier team. The right candidate will be responsible for the electronic and paper billing of medical claims. They must have an in depth understanding of the different types of claim forms along with coding requirements. The Direct Carrier Billing Specialist will also need to have an understanding of clearinghouse requirements and rules.

Hours: Day shift, 40-hour work weeks. During training, 8am - 5pm. Flexible schedule options available between 7am - 7pm after six months of employment.

Setting: Professional office environment with a hybrid work from home opportunity available after six months of employment based on performance.

Compensation: This is an exempt position at a very competitive salary. Our comprehensive benefit package includes health and dental benefits, short-term disability plans, 401k with company matching, paid time off policy and more. We also offer an onsite gym, cafe, and coffee shop.

Training: The Rawlings Company takes great pride in providing exemplary training and development program, including policies and procedures, state-of-the-art proprietary systems, and many other tools to place new employees on the path to success.

Responsibilities

• Audit claims for procedure and ICD coding along with proper use of modifiers.
• Correcting rejected claims and resubmitting
• Filing medical insurance appeals
• Maintaining and adhering to the responsibility for our clearinghouse and their rules and regulations.
• Maintains and records all communication with insurance companies and keeps a follow-up schedule.
• Communication with insurance companies.
• Performs other duties as assigned.

Qualifications

• Bachelor's Degree preferred or equivalent combination of education and experience in the health insurance, related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.
• At least two years of experience as a Medical Biller. Comprehensive understanding of insurance EOBs.
• Knowledge of insurance claim forms, including professional and institutional claims.
• Knowledge of Medical Coding, Modifier placement.
• Microsoft Word and Excel required.
• Professional oral and written communication skills, including excellent phone communication skills.
• Strong organizational and administrative skills.
• Ability to multi-task, work independently as well within in a team.
• Excellent time management and analytical skills required.
• Strong attention to detail and organizational skills.
• Always displays professional behavior in dealings with clients, members, peers, trainees, Audit management and any other individual with whom this position interacts. This applies equally to personal, written or telephone contact.

Physical Requirements

• Frequently remains in sitting position for long periods of time to perform duties.
• Frequently concentrates for long periods of time, paying close attention to detail.
• Frequently uses and views the computer using fingers, hands, and vision.
• Frequently works in a well-lit, tempered environment.
• Occasionally moves through office to communicate with other employees

The Rawlings Group is looking for hard-working, talented people who share our commitment to excellence to join our company. The Rawlings Companyhas successfully provided cost containment services to the largest health insurers in the country for more than 40 years and continues to grow as an industry leader.

Our Culture is focused on:

• The guiding principle of doing the right thing
• Caring for our employees and taking pride in the work they do
• Providing recognition and financially rewarding employees for their success

Our Values are:

• Integrity and Trust
• Customer Service Excellence
• Innovation
• Diversity and Inclusion
• Honoring our Veterans and Their Service

*Equal Employment Opportunity. It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.
*The Rawlings Group is an employment at will employer.

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