Medical Claims Specialist at VillageMD
Join VillageMD as a Medical Claims Specialist In Houston or Remote
Join the frontlines of today's healthcare transformation
At VillageMD, we're looking for a Medical Claims Specialist to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.
We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.
Could this be you?
As a Medical Claims Specialist, the position researches and processes institutional and professional claims. Provides subject matter expertise to departmental and corporate projects, analyzing and performing root cause analysis on all types of claims issues and adjustments. Serve as a primary point of contact to resolve issues requiring any and all other departments outside of Claims.
How you can make a difference
- Processes claims that pend for various hold reasons to assist in the final determination on claim disposition
- Processes adjustments related to projects or provider disputes providing timely follow-up provider call backs
- Acts as Claims Department subject matter expert on departmental and corporate projects. Supports business definition and testing efforts, attends project meetings, maintains project plans and provides internal and external status reports
- Works with management and associates to document current business and workflow processes and collaborates in identifying, defining and documenting process improvement options and alternatives
- Researches complex claims issues and works with other departments to resolve. Serves as primary liaison to all external departments, markets, and providers on claims related content
- Analyzes and trends claims issues, performs true root cause analysis and determines next steps for resolution and process improvement
- Researches issues, compiles feedback and drafts corresponding business requirements documents and business decision documents as needed
- Communicates changes in processes, project status and issue resolutions through email, memos, group presentations, and/or individual one-off meetings
- Performs special projects as assigned
Skills for success
- A bias for action and pragmatic solutions
- Ability to work quickly with great attention to detail
- Technical claims handling experience
- Knowledge of all products and all types of claims
- Computer literate with an above-average typing speed
- Demonstrate superb verbal and written communication skills
- Ability to work in a fast-paced environment with changing priorities
- Ability to work within tight timeframes and meet strict deadlines
- Ability to exercise sound judgment
- Prior experience as a Claims Analyst/Processor/Specialist or equivalent, ideally within a similar setting
- Ability to resolve conflict and diffuse tensions
- A low ego and humility; an ability to gain trust through strong communication and doing what you say you will do
Experience to drive change
- 5+ years of experience in claims processing commercial and Medicare claims.
- 3+ years of knowledge and experience in researching and resolving operational issues
- Previous visibility into Medicare and Medicare Advantage programs is a huge plus!
- EZ-CAP software experience is highly preferred
- High school diploma or equivalent is required
How you will thrive
In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.
Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.
Our unique VillageMD culture – how inclusion and diversity make the difference
At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
Explore your future with VillageMD today.