Claims Processing Specialist, Bilingual – Spanish

Role Overview

• Facilitates data processing and processes claims for NEMT and GMR rides.
• Performs reconciliation of billing data to encounter data.
• Works closely with the operations team to resolve issues.
• Work with internal operations and project teams to solve claims-related problems, benefit plans research and provider contract interpretation and configurations.
• Communicate and work with providers to get claims issues resolved and paid accurately and in accordance with healthcare/Medicare/Medicaid regulations, policies, and payment policies and guidelines.
• Receive incoming calls from providers, customers, vendors, and internal groups, to successfully analyze the caller's needs, research information, answer questions, and resolved issues and/or disputes in a timely and accurate manner.
• Identify issues negatively impacting the provider community including but not limited to system set up, required benefit modifications, EDI logic, provider education, claim examiner errors, and authorization rules.
• Develops and implements policies, processes and procedures that incorporate industry best practices, and reinforces high quality standards within the Billing team.
• Served as the Billing team’s subject matter expert and primary contact for claims related projects and critical activities.
• Mentors junior team members and provides internal claims team training, coaching, guidance, and assistance with complex issues.
• Implement: Scalable and accurate billing operations systems leveraging best in class technology. This includes financial reporting for management, clients and designated state and federal agencies (e.g., HHSC in Texas).
• Champion and reinforce SafeRide’s culture.

Requirements

• Minimum 1 years of experience in billing/claims management
• Must be bilingual Spanish Speaking
• NEMT/transportation background preferred
• Knowledge of CMS/HHSC regulations preferred
• Strong data skills in Excel/Sheets, including pivot tables, v-lookups, etc.
• Self-starter, ability to work independently and in a team environment.
• Strength in problem solving, applying hard data and qualitative insight to frame problems and develop novel solutions
• Ability to adapt to unforeseen circumstances quickly
• Keen attention to detail
• Ability to work with a variety of stakeholders

Benefits

• An inclusive, encouraging and collaborative company culture
• Strong support for career growth, including access to our investor communities
• Competitive compensation with upside for growth (including stock options and performance grants)
• Competitive benefits including health/vision/dental insurance, 401k match and 18 day ’s PTO