Claims Submission Specialist

RAYUS now offers DailyPay! Work today, get paid today!

The pay range for this position is $20.70 -$29.93 based on direct and relevant experience.

RAYUS Radiology is looking for a Claims Submission Specialist to join our team. We are challenging the status quo by shining light on radiology and making it a critical first step in diagnosis and proper treatment. Come join us and shine brighter together! 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. This role prevents claims errors, minimizes denials and supports accurate claim submissions by proactively correcting insurance information before the date of service.The Claims Submission Specialist is a member of the Revenue Cycle Management (RCM) Department that manages billing exceptions, payer maintenance, eligibility-related updates, and pre-service insurance reviews to improve claim accuracy, reduce denials and support timely reimbursement. This is a remote Full time position working Monday- Friday, working corporate day shift.

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), increase monthly gross collections and support overall improvement in collection percentages
• Meet or exceed established RCM quality assurance standards, ensuring accuracy, compliance and consistency in all assigned responsibilities
• Clear Rejections: Review and resolve claim rejections within clearinghouse applications to minimize reimbursement delays; escalate complex billing items to leadership with appropriate notation
• Verify Eligibility: Validate active member coverage and details before resubmitting modified claims
• Maintain Payers: Add, update, or terminate insurance payer profiles within company databases to preserve information accuracy
• Coordinate Coverage: Review and configure coordination of benefits rules within the systems to ensure accurate primary, secondary and tertiary payer ordering
• Update Variances: Adjust demographic details and name variances on billing records in strict alignment with official insurance payer documentation
• Research Account Data: Investigate patient chart documentation across all applicable software systems to locate accurate billing data and missing account details
• Worklist Maintenance: Manage assigned billing worklists and daily queues according to established standard operating procedures
• Process Pre-Service Reports: Complete daily PSV reports thoroughly, by proactively reviewing upcoming accounts to verify eligibility, authorizations, payer information and other requirements, resolving issues prior to the scheduled service date
• Identify, monitor and communicate workflow trends, issues and opportunities for improvement to departmental leadership
• Communicate effectively and timely with patients, insurance carriers, team members, centers, markets and referral sources to facilitate accurate claim submissions and ensure claims are processed successfully by payers
• Effectively prioritize workload by focusing on high-impact and priority tasks that drive financial performance and support achievement of organizational objectives
• Actively contribute to a positive, collaborative team environment and support departmental goals through teamwork and shared accountability

(5%) Other Duties and Projects as Assigned