About the job
ISTA Solutions, a leader in outsourcing and offshoring, is on the lookout for a highly skilled Claims Specialist to become an integral part of our rapidly growing team. Here, you will collaborate with a group of dedicated professionals who prioritize employee well-being and maintain a healthy work-life balance. At ISTA Solutions, we foster a culture committed to sustainable success and lifelong learning. We are seeking an enthusiastic team player eager to contribute to our shared mission!
Roles and Responsibilities
Team Lead
- Oversee daily operations to ensure that all agents provide high-quality, valued services.
- Conduct training sessions and coaching, offering insights and strategies for improvement.
- Analyze productivity and performance metrics, including attendance, end-of-day reports, and adherence to company protocols.
- Maintain communication with clients regarding essential program updates, challenges, and concerns through calls, emails, meetings, and reports.
- Perform other supervisory tasks as needed.
Claims, Denials, and EOB Management
- Verify insurance eligibility through EOB reviews.
- Utilize systems like Waystar and PointClickCare to confirm residents’ insurance coverage.
- Review and validate various insurance types such as Medicare, Medicaid, HMO, and other payers.
- Determine eligibility for billing and reimbursement based on coverage.
- Analyze claims denied due to provider-related issues.
- Document reasons for denial based on payer feedback or system records.
- Escalate findings and necessary corrections to the onshore team for follow-up with providers.
- Track denied claims and monitor their status until the required information for resubmission is obtained.