Pinnacle Technology · 7 hours ago
Claims Specialist
Texas, United States
Contract
Hybrid
Entry, Mid Level
$21/hr - $23/hr
2+ years expPinnacle Technology is seeking a Claims Specialist to manage and resolve claims and denials for various insurance companies. The role involves reviewing Explanation of Benefits, contacting insurance carriers, and preparing appeals to maximize collections.
ConsultingInformation TechnologyOutsourcingSoftware
Hiring Manager
Aditya Verma
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
Required
Must Reside in DWF, TX area. Open to looking at candidates from outside DFW but in TX
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
Pinnacle Technology
Pinnacle Technology provides staffing solutions, outsourcing, and systems integration services.
201-500 employees
Funding
Current Stage
Growth StageRecent News
GlobeNewswire News Room
2025-02-21
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