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Pride Health · 6 hours ago

Claims Specialist

Dallas, TX

Contract

Hybrid

Mid Level

$20/hr - $22/hr

4+ years exp

Pride Health is seeking a Claims Specialist for a remote work opportunity. The role involves reviewing Explanation of Benefits, contacting insurance carriers, resolving claim denials, and preparing appeals to maximize collections.

Health CareHuman ResourcesInformation Technology

Growth Opportunities

Responsibilities

Contact payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and request for additional information

Interpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection

Make necessary adjustments as required by plan reimbursement

Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement

Review, research and appeal partially denied claims for reconsideration

Responsible for contacting patients to gain additional information required to resolve outstanding insurance balances

Function as resource person for departmental personnel to answer questions and assist with problem resolution

Review and resolve provider NPI/TPI claim edits rejections

Review and resolve provider NPI/TPI claim denial

Assist with working Claim Edit Work queues

Assist with working Team Lead Work queues

Assist with New Hire Training

Performs other duties as assigned

Qualification

Medical claims recoveryInsurance verificationManaged Care knowledgeMedicare knowledgeMedicaid knowledgeProblem resolutionCommunication skillsTeam collaboration

Required

High School Diploma or Associate's Degree

4 years experience in medical claims recovery and/or collections with High School Diploma

2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree

Company

Pride Health

Pride Health is a staffing and recruiting company that provides account management and staffing solutions.

Founded in 2010

New York, New York, USA

51-200 employees

http://pride-healthcare.com

Funding

Current Stage

Growth Stage

Leadership Team

Stephanie Barnes

Scheduling Lead PHC/OPWDD

Recent News

TNGlobal

Thailand's Pride Health raises $300,000 to boost LGBTQ+ healthcare across Asia

2025-11-07

DealStreetAsia

SEA Digest: SG's Wiz.AI, Thailand's Pride Health raise funding

2025-11-06

Company data provided by crunchbase