Job Description

Billing Claims Specialist

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.

Rapidly growing and successful national medical equipment manufacturer and provider seeking an experienced Billing Claims Specialist to work with Medicare, Medicaid, Commercial Insurance companies and customers for claims submission and follow up. Primary responsibilities will include submitting claims, posting payments, working payor rejections and denials, and completing follow ups to ensure accurate and timely processing and payment, following all applicable compliance and regulatory processes. The role requires experience in medical billing and claims processing. Skilled in investigating and appealing denied claims. Preferably has experience with Medicare, Medicaid and Commercial payers.

This position will report to the Billing Supervisor. The role is full time, exempt and located at our Dallas, TX Facility. This role requires a hybrid schedule in our Dallas, TX office. Please confirm your ability to work onsite 3 days a week.

Note: Applications indicating an inability to work onsite will be immediately disqualified from consideration.

Essential Duties and Responsibilities:

Ensure timely and accurate billing of claims via electronic or paper to Medicare, Medicaid, and Commercial Insurances in accordance with policy using primarily Niko Health claim submission software and Salesforce.

Work with all payers to ensure medical claims are being processed timely and paid accurately.

Analyze and post EOB payments and denials in all billing systems, ensuring correct processing and payment. Determine root cause and prevention of future rejections & denials, advising management and appeals team where necessary.

Route claims and/or balances that are deemed uncollectible to Financial Patient Responsibility Review or Write Off Queues timely and appropriately.

Assist and communicate effectively with our patients, doctors, customers, and coworkers with billing inquiries at the highest-level support possible.

Able to Identify process improvement opportunities and recommend potential solutions to improve departmental workflow.

Assist with any other duties or projects on an as needed basis.

Maintain regular and punctual attendance.

Comply with all company policies and procedures, HIPAA and all state and federal regulations.

Must meet or exceed production & quality KPI standards.

Minimum Qualifications:

Education, Experience and Training:

Able to operate at a task and project level.

High School diploma or equivalent, required.

Some College and/or medical billing certificate, preferred.

2 years of Medicare, Medicaid and/or Commercial Insurance experience, particularly in HME, highly preferred.

Intermediate knowledge/proficiency in Microsoft Office products and Salesforce, highly preferred.

A combination of training, education and experience that is equivalent to the qualifications listed above and that provides the required knowledge, skills, and abilities required.

Knowledge, Skills and Abilities:

A comprehensive understanding of Medicare, Medicaid, and/or Commercial Insurance program rules as it pertains to DME billing.

Ability to take direction and communicate effectively with customers and employees at all levels of the organization.

Ability to thrive in a fast-paced and dynamically changing organization.

Must have a strong work ethic.

Excellent oral and written communication skills required.

Strong attention to detail

Ability to prioritize and manage daily responsibilities effectively

Solutions-oriented problem solver

Excellent planning, communication and organizational skills.

Core Competencies:

Continuous Improvement, Problem Solving, Service Focus, Collaboration, Team Communication, Change Agility, Mission & Vision Focus, Stewardship

Physical Functions and Work Environment:

The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Salary: $55,000 - $60,000 per year

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