[Hiring] Claims Submission Specialist @RAYUS Radiology

Role Description

RAYUS Radiology is looking for a Claims Submission Specialist to join our team. As a Claims Submission Specialist, you will be responsible for:

• Identifying and resolving medical claim related issues (pre-claim submission)
• Monitoring billing rejections and maintaining accurate insurance records
• Preventing claims errors, minimizing denials, and supporting accurate claim submissions by proactively correcting insurance information before the date of service

This role is a member of the Revenue Cycle Management (RCM) Department that manages:

• Billing exceptions
• Payer maintenance
• Eligibility-related updates
• Pre-service insurance reviews to improve claim accuracy, reduce denials, and support timely reimbursement

This is a remote full-time position working Monday-Friday, during corporate day shift hours.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• (95%) Claims Duties
  • Review pre-service validation (PSV) reports generated through system edits
  • Audit upcoming appointments to verify authorizations, member IDs, group numbers, and payer assignments based on service locations
  • Contribute to the reduction of days sales outstanding (DSO) and increase monthly gross collections
  • Meet or exceed established RCM quality assurance standards
  • Clear Rejections: Review and resolve claim rejections within clearinghouse applications
  • Verify Eligibility: Validate active member coverage and details before resubmitting modified claims
  • Maintain Payers: Add, update, or terminate insurance payer profiles within company databases
  • Coordinate Coverage: Review and configure coordination of benefits rules within the systems
  • Update Variances: Adjust demographic details and name variances on billing records
  • Research Account Data: Investigate patient chart documentation across all applicable software systems
  • Worklist Maintenance: Manage assigned billing worklists and daily queues
  • Process Pre-Service Reports: Complete daily PSV reports thoroughly
  • Identify, monitor, and communicate workflow trends, issues, and opportunities for improvement
  • Communicate effectively and timely with patients, insurance carriers, team members, centers, markets, and referral sources
  • Effectively prioritize workload by focusing on high-impact and priority tasks
  • Actively contribute to a positive, collaborative team environment
• (5%) Other Duties and Projects as Assigned

Qualifications

• High School Diploma, or equivalent
• Two (2) years' experience in healthcare billing exceptions, claim rejections, insurance denials, or revenue cycle workflows
• Experience in electronic health records, medical billing software, and clearinghouse applications
• Proficient in Microsoft Excel, Word, and Outlook

• Preferred:
• Graduate from an accredited medical billing program
• Experience in Nextgen and Waystar

Benefits

• Medical, dental, and vision insurance
• 401k with company match
• Life and disability insurance
• Tuition reimbursement
• Adoption assistance
• Pet insurance
• PTO and holiday pay
• Many more benefits (based on eligibility)

Company Description

RAYUS is committed to delivering clinical excellence in communities across the U.S., driven by our passion for and superior service to referring providers and patients. RAYUS Radiology is built on:

• Brilliant medicine
• Brilliant team
• Brilliant technology and services

We bring brilliance to health and wellness. Join our team and shine the light on Radiology Services! RAYUS Radiology is an EO Employer/Vets/Disabled.