Direct Carrier Billing Specialist

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This position will be hybrid, with opportunity to work full remote after training as well as in our La Grange, KY.

About the Opportunity

At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Carrier-to-Carrier team, the Direct Carrier Billing Specialist is responsible for the electronic and paper billing of medical claims. They must have an in depth understanding of the different types of claim forms along with coding requirements. The Direct Carrier Billing Specialist will also need to have an understanding of clearinghouse requirements and rules.

What you’ll do

• Audit claims for procedure and ICD coding along with proper use of modifiers.
• Correcting rejected claims and resubmitting
• Follow clearinghouse rejections based on the assigned payers.
• Maintaining and adhering to the responsibility for our clearinghouse and their rules and regulations.
• Communicate any billing errors and trends identified per client.
• Communication with insurance companies.
• Performs other duties as assigned.

What experience you bring (Role Requirements)

• Bachelor’s Degree preferred or equivalent combination of education and experience in the health insurance, related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.  
• At least two years of experience as a Medical Biller. Comprehensive understanding of insurance EOBs.
• Knowledge of insurance claim forms, including professional and institutional claims.
• Knowledge of Medical Coding, Modifier placement.
• Microsoft Word and Excel required.
• Professional oral and written communication skills, including excellent phone communication skills.
• Strong organizational and administrative skills.
• Ability to multi-task, work independently as well within in a team.
• Excellent time management and analytical skills required. 
• Strong attention to detail and organizational skills.
• Always displays professional behavior in dealings with clients, members, peers, trainees, Audit management and any other individual with whom this position interacts.  This applies equally to personal, written or telephone contact.

What Success Looks Like…

After 3 months

You will have a strong understanding of the role.