Payer Operations Coding Specialist

1 Month ago • All levels • Operations • $31,200 PA - $37,440 PA

Job Summary

Job Description

Carda Health is seeking a Payer Operations Coding Specialist. This role involves ensuring revenue is maintained and handling coding concerns related to business operations. Key responsibilities include communicating with patients about insurance coverage and billing, working with ICD10 codes (certification preferred), assisting with claim validation and correction, managing claims reporting in Excel, and updating billing systems. The ideal candidate has at least one year of experience in an administrative medical setting, strong interpersonal skills, attention to detail, and knowledge of Medicare and Medicare Advantage Plans.
Must have:
  • Experience in administrative medical setting
  • Strong interpersonal skills
  • Attention to detail
  • Highly organized
  • Knowledge of Medicare/Medicare Advantage Plans
  • Experience with ICD10 codes (certified coder)
  • Experience with insurance verification/eligibility
Good to have:
  • Experience in Revenue Cycle Management (RCM)
  • Experience with claims that fail validation
  • Experience working with billing companies
  • Experience with Excel for reporting
  • Experience with EMR systems

Job Details

About Carda

Rehab is a pain. So much so that only 10% of qualifying Cardiac and Pulmonary patients attend. At Carda Health, we’ve reimagined rehab. Our program allows patients to complete inspiring, convenient, life-saving therapy remotely.

Who are we?

We are a team of clinicians, data scientists, mathematicians and repeat entrepreneurs. And a few recovering financiers. Our belief is that technology and data, when applied to the right problem, transforms people’s lives and changes even the most entrenched industries. Carda was founded by Harry and Andrew, two friends from Wharton who share a family history of heart disease and experience with poor access to care. We now work with some of America’s largest and top-ranked hospitals and most innovative insurers. We are fortunate to be backed by some of the best investors in the business who have also backed the likes of Livongo, Hinge, Calm, MDLive, and others.

Who are you?

You are motivated by the prospect of working at a fast-growing start-up. You are excited about the details but able to connect them back to bigger company goals. You are passionate about enabling others to do their jobs better and more efficiently — in this case expanding access to life-changing therapies. If you exhibit one characteristic above all others it is that of ownership. It personally bothers you when processes don’t work and you do everything in your power to prevent this from happening. You are a great collaborator and communicator who has experience both managing teams and working across teams to implement key initiatives. You are able to complete tasks and implement processes in ⅓ of the time of a peer.

What will you do?

The Business Operations Analyst will have executional and strategic responsibilities. You will have the opportunity to gain exposure to a myriad of experiences working at a venture backed startup from an early stage. Your primary focus or driving goal will be ensuring that revenue is maintained as well as handling any Coding concerns related to revenue and business operations. The key driver of our revenue is insurance claims so experience in Revenue Cycle Management (RCM) and a willingness to learn are critical to succeeding in this role. This role requires collaboration across the Carda team including everyone from our C-suite executives to our clinicians.

In a little more detail:

  • Communicate with patients daily to clarify insurance coverage and answer billing related questions
  • Working knowledge of ICD10 codes (certified coder)
  • Work with our billing company to complete tasks on claims that fail validation
  • Work with Excel to manage reporting on claims and claims operations
  • Work within our EMR and homegrown practice management system to correct patient data found to be inaccurate during the claim routing or adjudication process
  • Assist with insurance verification/ eligibility determination questions
  • Maintain updates in our billing system(s)
  • Other duties as assigned

What we look for:

  • A year of experience in an administrative medical setting working with patients
  • Strong interpersonal skills
  • Attention to detail
  • Highly organized
  • Knowledge of Medicare and Medicare Advantage Plans

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