Assistant Provider Claims Specialist

About Employer Direct Healthcare

Employer Direct healthcare (EDH) is on a mission to transform access to excellent care for the moments that matter most. As the leading provider of surgical benefits for self-insured employers, we bring guided access to high-quality, affordable care for employers, their employees and the family members. We understand and have experienced the challenges of navigating specialized healthcare and we are dedicated to making a change.

EDH is the market leader for Independent Centers of Excellence (CoE). We have challenged the status quo in healthcare by bringing top quality surgeons within reach of all. Our surgeon-first model is the largest and most accessible network (3-4x larger than our peers), which has delivered an ROI 3x our peers. We serve hundreds of self-funded plan sponsors across 1000+ employers, representing over 4 million people across the U.S. We've saved our clients over $700 million since we were founded! 

Ultimately, the US healthcare system at-large is flawed. Costs continue to rise while life expectancy stagnates. We are moving the needed on this problem by improving surgery outcomes - making people healthier - and lowering healthcare costs at the same time. 

 

About You:

• You have a drive and AMBITION to tackle big problems. Big problems require big ideas and a team that supports new ideas.
• You CARE deeply for your customers. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
• You thrive in a TEAM ENVIRONMENT. Collaboration is key in innovation and creating change.
• A DIVERSE environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
• You are DETAIL ORIENTED, but more so, focus on the execution of your content while balancing a fast-paced environment.
• You understand that PROGRESS is critical to making change. You take the time to celebrate the small and big wins. Understanding that each improvement to a process helps move towards a greater change.
• INTEGRITY guides you in life. Focusing on the truth versus just giving people the answers they want to hear.

 

If this sounds like you, we would love to connect to speak further about career opportunities at Employer Direct Healthcare.

Please apply to our role & someone from our HR Team will reach out to help you navigate our interview process.

 

Job Overview

The Provider Claims Assistant supports the billing and claims department by managing the data entry process to ensure contracts and records are up to date and accurate. This role will play a critical role by collecting and processing claims data, coordinating with providers, and ensuring timely and accurate payment processing. The Provider Claims Assistant builds trust and rapport with EDH’s providers’ administrative counterparts through responsiveness, content, customer service, problem solving and a consultative mindset.  Successful Provider Claims Assistants are highly organized, personable, resourceful, and self-starting.

THIS POSITION IS 100% ONSITE. We are located in Dallas, TX.

Responsibilities and Duties

• Act as the primary point of contact for provider claims inquiries and follow up on outstanding claims
• Perform data entry for the claims department related to contracts with clients and provider payments
• Review and assess provider claims to ensure compliance with company policies and procedures
• Collect and analyze claims data for accuracy, both in terms of claims submissions and payment processing
• Coordinate with providers to resolve any issues related to claims submissions, including documentation requirements, billing codes and payment processing
• Evaluate trends and identify opportunities to streamline claims processing and improve overall efficiency
• Maintain accurate and detailed records and documentation of claims processing activities
• Represent Employer Direct healthcare in a professional manner when communicating with providers, members, and other teammates.

Qualifications

• Bachelor degree preferred ; high school diploma required
• 1-3 years’ of experience in claims processing in a healthcare setting preferred
• Experience in a customer service or contact center environment
• Knowledge of medical billing codes and standards, as well as government healthcare regulations or willingness to learn
• Excellent communication and interpe