Claims Specialist

18 hours ago

Highland Beach, United States Quadrant Health Group Full time

Join our dynamic team at Quadrant Health Group Quadrant Billing Solutions, a proud member of the Quadrant Health Group, i s seeking a passionate and dedicated Claims Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively. Why Join Quadrant Health Group? Competitive salary commensurate with experience. Comprehensive benefits package, including medical, dental, and vision insurance. Paid time off, sick time and holidays. Opportunities for professional development and growth. A supportive and collaborative work environment. A chance to make a meaningful impact on the lives of our clients. Compensation: $18 - $24 per hour - Full-time What You'll Do: The ideal candidate is organized, persistent, and results-driven, with deep knowledge of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You’ll join a high-performing team focused on maximizing collections, reducing aging A/R, and ensuring every dollar is pursued. Major Tasks, Duties and Responsibilities: Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care. Manage 500–700 claims per week , prioritizing efficiency and accuracy. Handle 4–5 hours of phone time per day with strong communication skills. Communicate with payers via phone, portals, and written correspondence to resolve billing issues. Identify trends in denials and underpayments and escalate systemic issues. Dispute and overturn wrongly denied claims . Update and track claims using CMD (CollaborateMD) and internal task systems. Follow QBS workflows using Google Drive, Docs, Sheets, and Kipu EMR . Maintain professional and timely communication with internal teams and facility partners. Bonus Experience (Not Required): Handling refund requests and appeals . Preparing and submitting level 1–3 appeals (e.g., medical necessity, low pay, timely filing). Gathering and submitting medical records for appeal support. Working with utilization review (UR) or clinical teams. Familiarity with ASAM and MCG medical necessity criteria . Exposure to payment posting, authorization reviews , or credentialing . What You'll Bring: Minimum 1 year of SUD/MH billing and claims follow-up experience (required). High School Diploma or equivalent, associate or bachelor’s degree (preferred). Strong understanding of insurance verification, EOBs, and RCM workflows . Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest . Experience overturning insurance denials is a strong plus . Proficient in CMD (CollaborateMD) and Kipu EMR (strongly preferred). Excellent written and verbal communication skills. Highly organized, detail-oriented, and capable of managing multiple priorities. Why Join Quadrant Billing Solutions? Rapid career growth in a mission-driven, niche billing company. Collaborate with clinical and billing experts who understand behavioral health. Join a tight-knit, supportive team culture. Gain opportunities for leadership advancement as the company scales. HP Compensation details: 18-24 Hourly Wage PI1c60ed56e54c-25448-38267920aa415a4b-8b21-40fc-a65c-70d2b25ca29a

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