Job Description (Claims Specialist)
Location – Hybrid (NCR)
About Sciometrix
At Sciometrix, our goal is to deliver the best-ever personalized care with utmost compassion enabling patients to lead healthier and happier lives. Our commitment to innovation in healthcare technology drives us to lead the way in Care Management, Digital Care Coordination, Value-Based Care, and Population Health. We envision a world where advanced technology and human compassion intersect seamlessly to deliver superior patient experiences and outcomes.
Our mission is to enhance the lives of patients by leveraging digital solutions that reduce hospital readmissions, improve health outcomes, and optimize the delivery of healthcare services.
At the heart of our philosophy lies the belief that every patient deserves access to the highest quality of care, tailored to their individual needs. We strive to make this vision a reality by pioneering innovative solutions that prioritize patient well-being and provider efficiency.
With Sciometrix, the future of healthcare is not just about treating illnesses; it's about empowering patients to live their best lives.
What's in it for you Innovative & Diverse Healthcare Startup Culture
Join a forward-thinking digital health company where your expertise in claims processing and reimbursement directly supports sustainable virtual care delivery. We foster an inclusive, dynamic environment where every team member's accuracy and accountability contribute to operational excellence and financial performance.
Collaborative, Cross-Functional Team Environment
Work closely with coders, billing specialists, revenue cycle leaders, clinicians, and support teams to ensure timely claim submission, denial management, payment posting accuracy, and efficient follow-ups. Your role will be essential in strengthening revenue cycle performance and supporting exceptional provider and patient experiences.
Cutting-Edge Telehealth Technology
Be part of the evolution of telehealth and virtual care management. Gain access to proprietary, HIPAA-compliant software and advanced AI-driven tools like Clinicus that streamline claims workflows, improve documentation accuracy, and enhance reimbursement efficiency.
Impactful Role In Healthcare Operations
Make a meaningful difference by ensuring accurate claim submissions, proactive denial resolution, compliance with payer guidelines, and optimized reimbursement turnaround times. Your attention to detail directly supports financial stability and continuity of care.
Global Network & Professional Growth
Expand your professional network while working alongside healthcare and technology professionals worldwide. Be part of an organization that embraces innovation and supports ongoing development within the evolving landscape of revenue cycle management.
Commitment To Diversity, Inclusion & Belonging
We are committed to building a safe, inclusive workplace where every team member feels respected and empowered. Our leadership prioritizes creating an environment where you can bring your authentic self to work.
Competitive Compensation & Benefits
Enjoy a competitive salary aligned with your experience, along with benefits designed to support your well-being and work-life balance, including remote work opportunities, health insurance coverage, accidental wellness cover, company-provided devices, internet reimbursement, paid leaves, and optional holidays.
Positive & Rewarding Work Environment
Join a company recognized for clinical excellence, patient satisfaction, and provider success — where your contributions to claims accuracy, denial reduction, and revenue optimization are valued, supported, and celebrated.
We're seeking a Claims Specialist with 4+ years of US healthcare industry experience in AR calling and denial management. You should excel in written and verbal communication, work autonomously, and possess a strong grasp of Revenue Cycle Management and insurance denials. Proficiency in EMR platforms like EPIC, AdvancedMD, and knowledge of medical billing procedures and codes are crucial. Experience in Telehealth processes, especially RPM and CCM, is preferred. If you're detail-oriented, proactive, and passionate about enhancing patient care through technology, we invite you to apply.
Job Responsibilities
- Review and verify Patient balance to provide resolution on open AR patient accounts.
- Investigate and resolve Denial/rejection discrepancies in insurance claims.
- Ensure timely follow-up with Insurance on the claims pending for payments via call/websites to insurance carriers to obtain and take appropriate actions to resolve the claims in timely manner.
- Research and understand insurance guidelines, requirements, and changes related to resolve the Account balance stuck in patient accounts.
- Reconcile accounts receivable to ensure accurate and up-to-date financial records.
- Communicate and coordinate effectively with the finance team to accurately process payments and handle any billing-related concerns.
- Provide inputs and share best practice to improve the AR capabilities.
- Ability to perform patient eligibility.
Requirements
- Should be working as an Claims Specialist with proven minimum 4 years of experience in AR calling and denial management in US healthcare industry.
- Excellent written and verbal communication skill.
- Should be able to work independently without any supervision.
- Good knowledge of Revenue Cycle Management and insurance denials.
- Good understanding on different EMR platforms (EPIC, AdvancedMD, ECW,
Practice fusion etc).
- Familiarity with healthcare billing software and systems, especially AdvancedMD and Way star billing platforms.
- In-depth knowledge of medical billing procedures, codes, and regulations, including knowledge of CPT, ICD-10, and HCPCS code
- Knowledge of Telehealth – RPM and CCM process is highly preferred.
Equal Opportunity
Sciometrix is an Equal Opportunity Employer and is proud to offer equal employment opportunity to everyone regardless of race, color, ancestry, religion, gender, national origin, sexual orientation, age, citizenship, disability, gender identity, veteran status, and more.
Skills: eligibility,healthcare,telehealth,denials,ar system
