Value Based - Claims Specialist

At Holista, we are more than just a company – we are a community of passionate, dynamic and highly skilled professionals committed to transforming the healthcare experience for patients, providers and payers. Our dedication to quality drives us to innovate and deliver technology-enabled solutions that make healthcare feel like care again.

Important things YOU should know:   

• Schedule: Monday – Friday, 8:00am – 5:00pm CST
• Potential to Flex Schedule
• Fully remote opportunity!  

What will YOU be doing for us at Holista? As a Value Based – Claims Specialist you will have the opportunity to contribute to the success of our rapidly-growing organization. To be successful in this role, you are required to have 2+ years of medical billing and/or collections experience. The ideal candidate will possess a high attention to detail and have exceptional organizational skills. You will work closely with others on the Claims team to investigate and rectify any account discrepancies and provide proper documentation, as requested by the customer.

What will YOU be working on?

• Utilize the claims management real time dashboard to effectively and efficiently process claims/payments and resolve exceptions.
• Ensure facility/trigger claims from providers are received and processed correctly
• Submit funding claims to appropriate Payers and ensure the claims process correctly through the clearinghouse (Optum) and if claims are rejected submit corrected claims in a timely manager
• Provide input to the operations team for effectively identify stable/unstable processes, variation, and root cause analyses. 
• Prepare daily check-runs for provider claim payments once funding is received
• Ensure all KPIs related to Holista’s claims processing are met and if KPIs are not met provide communication to Leadership on the root-cause
• Manage and update bundle constructs if coding or pricing needs to be corrected or added for any new bundles.
• Work collaboratively and synchronously with the Service Line Owners and “gear masters”
• Research and resolve payment discrepancies and communicate with team leads on how to resolve
• Liaison between members and providers to resolve billing issues and effectively track issues to provide status to the applicable “gear masters” and/or clients.

Additional Responsibilities:

• Develop and/or communicate methods to improve productivity and efficiency.
• Assist with gathering data for client audits.
• Contribute to the team effort by accomplishing additional responsibilities as needed

What qualifications do YOU need to have to be a GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates.
  • Associates Degree or equivalent years of experience in a client-facing role.

• Required Level of Experience
  • 2+ years of medical billing and collections experience.

• Required Knowledge, Skills, and Abilities
  • Intermediate knowledge of MS Office Suite such as Excel, Word and Outlook.
  • Ability to remain organized with multiple interruptions.
  • Demonstrated success with time management to ensure project timelines and client deadlines are met.
  • Ability to work with a diverse group of internal and external individuals.
  • Professional demeanor; Effective customer service mindset and communication skills both in person and in written documents.
  • Ability to effectively present thoughts and respond to questions in a public speaking opportunity.
  • Ability to follow, design, document workflows necessary for good business practice. 

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, Licenses, and/or Certificates
  • Bachelor’s degree in a related field.    

• Preferred Level of Experience
  • 3+ years of medical billing and collections experience.

• Preferred Knowledge, Skills, and Abilities
  • Advanced knowledge of MS Office Suite

Compensation Range:

Compensation Midpoint: