AR Claims Specialist

Sagis Diagnostics is an entirely physician-led sub-specialty pathology group supported by a CAP-accredited histology lab located in the heart of Houston, Texas. Led by a team of board-certified pathologists, our lab is at the forefront of diagnostic science. We offer the highest quality services to physicians, physician groups, ambulatory surgery centers, and hospitals. One of our many strengths is we develop strong collaborative relationships with each of our referring physicians by offering accurate, prompt, and clear diagnoses in a personal and customized manner.

Sagis, PLLC is seeking an AR Claims Specialist to join our fast-paced organization. The AR Claims Specialist will be responsible for analyzing Pathology and Laboratory claims information to determine eligibility in the dispute resolution process in accordance with established Federal regulations and company policies and procedures.

Responsibilities of the Claims Specialist may include but are not limited to:

• Analyze patient accounts and identify any improper or missing data such as Pt. demographics, Insurance information, CPT codes or ICD codes. Make corrections in the billing software on patients accounts to ensure that files are updated and correct. Analyze Explanation of Benefits (EOB) and payment remittance documents submitted by healthcare providers and Insurance carriers to determine which claims need re-submission, reconsiderations, Appeals or have escalated to management for review to make a final determination.
• Compose correspondence in accordance with regulatory requirements (and internal policies in procedures) in a clear, concise, and grammatically correct manner.
• Communicate (via e systems) with health plans to obtain information necessary to determine the eligibility of the claim, status or reason for denial.
• Relay the status of all claim submissions utilizing multiple different operating systems.
• Stay up to date on industry specific regulations, ensuring that appropriate strategies are in place.
• Maintain physical and electronic files for all claims determined eligible.

FLSA: Non-Exempt, Regular Full Time, Hourly

Pay: $23.00 - 26.00 per hour, DOE

Work Location: In person, 5 days per week at our Houston corporate office.

• Minimum of 2+ year’s experience working in Medical Billing & Collections, Denials, Appeals within a Medical setting.
• High School Diploma or GED required.
• Certification as Medial Billing Insurance Specialist or Certified Procedural Coder preferred. 2+ years’ continuous work experience working in a healthcare setting in Lieu of Certification will be accepted.
• Experience reviewing all types of medical claims, EOBs, and payment remittances (e.g. HCFA 1500, Outpatient, Podiatry, Dermatology, Gastroenterology, Toxicology but not limited to other specialties. Complicated claims, COB and understanding of Medical Insurance plans.
• Understanding of insurance reimbursement rules and meeting claim quotas per day
• Ability to work at a high level and display high attention to detail.
• Ability to work across multiple operating systems.
• Ability to identify improper billing patterns and make corrections for future related issues
• Ability to maintain confidentiality and professionalism in difficult situations.
• Strong written and verbal communication skills with the ability to explain reasoning effectively.

Why Work at Sagis?

We offer:

• Medical, Dental, and Vision Insurance
• Company-Paid Short-term and Long-term Disability, Basic Life, EAP
• Voluntary Accident/Critical Illness/Life insurance
• 401(k) Contribution
• Paid Time Off
• 6 Paid Holidays
• 2 Floating Holidays
• Health and Wellness Initiatives