CLAIMS SPECIALIST II

Healix Infusion Therapy, LLC is currently seeking a qualified remote full-time Claims Specialist II to join our corporate business office and Business Office Team. Currently, the position is a remote work arrangement and qualified candidates must have access to home internet and a dedicated work space free from distractions.  Team members must have excellent communication skills and be able to professionally interact with patients, clients, and colleagues.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Include the following. Other duties may be assigned.

• AR Follow-Up: Review aging reports with management to prioritize aged and high dollar claim resolution.
• Insurance Verification & Claims Processing: Verify patient insurance coverage and benefits to ensure accurate claim submissions.
• Copay Management: Calculate, collect, and track patient copayments per visit, ensuring timely and accurate payment processing.
• Financial Assistance Enrollment: Research and enroll eligible patients into copay assistance programs or alternative financial aid resources to help offset healthcare costs.
• Record Keeping & Reporting: Maintain comprehensive records of billing and payment transactions; generate and review reports to monitor billing activities and ensure regulatory compliance.
• Communication & Issue Resolution: Collaborate with patients, providers, and insurance companies to address billing inquiries, resolve discrepancies, and provide support regarding financial obligations.
• Analysis: Review claim EOBs and correspondence to resolve denials of non-paid claims
• Special Projects as assigned
• Other duties as assigned

CORE DUTIES AND RESPONSIBILITIES:

Include the following basic performance factors all Healix, Inc. employees are expected to meet.

• Interacts professionally with clients and fellow employees.

• Cooperates with team members to accomplish departmental goals.

• Accepts and incorporates changes or new ideas into daily work.

• Provides service in a responsive, timely and accurate manner to both clients and fellow employees.

• Understands and adheres to policies and procedures.

• Arrives to work as scheduled and notifies supervisors in a timely manner of any absences.

• · Recognizes priorities and acts; makes productive use of time.

• Strives to resolve problems and conflicts on his/her own initiative.

• Attempts to create new ideas or new procedures working as part of a group or individually.

• As a part of your job, you will receive protected health information. It is your duty to comply with HIPAA in using and disclosing that protected health information.

• Ability to remain focused, productive and available during company business hours while working remotely.

• Maintain and adhere to productivity standards by providing updates of daily tasks completed to management

About Us

Healix is the nations leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 30 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, and clinical outcomes in an outpatient setting.

At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. We use our clinical and business expertise to provide integrated solutions to improve all aspects of the infusion program, all while delivering peace of mind to our clients and their patients.

Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, and payors, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent. Our physician clients rely on Healix to handle all facets of infusion center operations, including drug purchasing, revenue cycle management, managed care programs, and clinical staffing. As Healix continues to leverage unique industry expertise in management and service markets, we are dedicated to maintaining focus on patient and physician peace of mind.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Medical Billing & Coding Expertise: Proficient in billing practices and familiar with CPT, ICD-10, and HCPCS coding standards.
• Insurance Knowledge: Solid understanding of insurance plans, benefits coordination, and claims adjudication processes.
• Communication Skills: Strong interpersonal and customer service skills to effectively interact with patients, insurance representatives, and healthcare providers.
• Problem-Solving: Capable of analyzing billing issues, identifying discrepancies, and implementing corrective actions.
• Attention to Detail: Meticulous in claim submission, payment posting, and maintaining accurate records to prevent billing errors.
• Organizational Skills: Ability to manage multiple tasks, prioritize assignments, and meet deadlines in a high-volume, fast-paced work environment.

EDUCATION and/or EXPERIENCE

• Two to three years in electronic claims submission and medical collections. Proficiency in MS Excel. Knowledge of Copay Assistance Programs preferred. Experience in Infusion billing and collections is strongly preferred.

CERTIFICATES, LICENSES, REGISTRATIONS

• This job does not require any certificates, licenses, or registrations.

EQUAL EMPLOYMENT OPPORTUNITY 

We are an Equal Employment Opportunity employer committed to providing equal opportunity in all of our employment practices, including selection, hiring, assignment, re-assignment, promotion, transfer, compensation, training, leave of absence, discipline, and termination. The Company prohibits discrimination, harassment, and retaliation in employment based on race; color; religion; national origin; sex; pregnancy, childbirth, or related medical conditions; age; disability or handicap; citizenship status; service member status; or any other category protected by federal, state, or local law. Healix has a non-discrimination policy and complies with applicable federal, state and local laws governing nondiscrimination in employment in every location in which the Company has facilities.