Rightway · 19 hours ago
Billing and Claims Specialist
Denver, CO
Full-time
Onsite
Entry, Mid Level
$22/hr - $25/hr
2+ years expRightway is on a mission to harmonize healthcare for everyone, everywhere. The Billing and Claims Specialist role involves determining coverage for medical procedures, resolving claims and billing questions, and maintaining quality customer service while adhering to HIPAA guidelines.
Health CareMedical
Responsibilities
Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy
Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners
Initiates investigation of questionable claims
Resolves medical, dental, and vision claims and billing questions and issues by examining the summary of benefits, contacting the carrier and/or the provider billing office to ensure the member is not being overcharged, calculating out-of-pocket costs based on benefits, initiating reimbursement requests with the carrier, composing appeal letter
Provides information on year-to-date deductible, copay, and coinsurance activity to team members
Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
Protects claimant information by following HIPAA guidelines
Reports claim status updates in proprietary CRM and provides detailed information on each claim
Qualification
Required
Determines coverage for medical, dental, and vision procedures by studying provisions of the member's health policy
Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners
Initiates investigation of questionable claims
Resolves medical, dental, and vision claims and billing questions and issues by examining the summary of benefits
Contacts the carrier and/or the provider billing office to ensure the member is not being overcharged
Calculates out-of-pocket costs based on benefits
Initiates reimbursement requests with the carrier
Composes appeal letter
Provides information on year-to-date deductible, copay, and coinsurance activity to team members
Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
Protects claimant information by following HIPAA guidelines
Reports claim status updates in proprietary CRM and provides detailed information on each claim
Strong communication skills, both written and verbal
Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication
Strong demonstration of critical thinking and problem-solving skills
Preferred
Bachelor's degree in health sciences or related field and minimum of 2 years of experience as a medical claims specialist preferred
Company
Rightway
Rightway is a health technology company that is simplifying the healthcare experience for clients and members.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$238.75MKey Investors
Khosla VenturesThrive CapitalTiger Global Management
2024-03-29Series Unknown· $108.75M
2021-03-30Series C· $100M
2019-11-21Series B· $20M
Leadership Team
Jordan Feldman
Co-Founder and CEO
Ryan Belkin
Executive Vice President & Head of Growth
Recent News
2025-12-11
Company data provided by crunchbase