Claim Assistant Jobs in Boca Raton, FL (NOW HIRING)

NO WEEKENDS, NO EVENINGS, NO HOLIDAYS

We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package!

Benefits:

· Health insurance

· Dental insurance

· Vision insurance

· Life Insurance

· Pet Insurance

· Health savings account

· Paid sick time

· Paid time off

· Paid holidays

· Profit sharing

· Retirement plan

GENERAL SUMMARY

The Insurance Accounts Receivable Specialist III handles the most complex claim scenarios and plays a key role in mentoring staff and supporting escalated issues. Responsibilities include resolving out-of-network claims, reviewing and writing appeals, assisting with training, and serving as a resource for team members. This role requires advanced knowledge of billing practices, payer requirements, and a high level of independence and accuracy in claim resolution.

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Perform billing-related tasks assigned, including data entry, claim review, charge review, and accounts receivable follow-up.
• Focus on resolving high-complexity insurance accounts, including denials related to medical necessity, non-covered services, bundling, out-of-network claims (OON), and other advanced claim scenarios.
• Manage a greater volume and complexity of work than Levels I and II, while maintaining quality and meeting productivity standards.
• Complete daily tasks in assigned work queues in accordance with established workflows and manager direction.
• Utilize CBO Pathways, payer websites, billing systems, and training materials to resolve unpaid or incorrectly paid claims and to authorize procedures within expected timeframes.
• Identify and escalate payer issues, credentialing discrepancies, or coding concerns to management as needed.
• Follow standard workflows as provided in training and proactively seek further education or clarification when necessary.
• Review reports to identify revenue opportunities and outstanding claims requiring follow-up.
• Adhere to departmental workflows, regulatory requirements, and FGP compliance and patient confidentiality guidelines.
• Communicate effectively with patients, providers, coders, and other stakeholders to ensure accurate and timely claims processing.
• Provide insight and feedback on system edits, billing processes, and procedural improvements to support revenue cycle efficiency.
• Maintain patient confidentiality and consistently apply policies and procedures to ensure compliance and operational consistency.
• Collaborate with colleagues, support departmental goals, and clearly explain processes and procedures to others as needed.
• Make corrections to system records to meet payer requirements and resubmit claims accordingly.
• Train and mentor new hires and provide guidance to team members as needed.
• Review and write appeals and assist staff in resolving complex claim or appeal-related questions.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Advanced knowledge of billing systems, denial management, and payer-specific requirements.
• Ability to coach, train, and mentor other team members.
• Strong analytical and decision-making skills; able to handle complex accounts independently.
• Ability to identify trends, propose solutions, and contribute to process improvements.
• Experience writing appeals and handling escalated claim issues.
• Skill in using computer programs and applications including Microsoft Office.

EDUCATION REQUIREMENTS

• High school diploma or equivalent required. Associates degree in related field preferred.

EXPERIENCE REQUIREMENTS

• Previous experience in a customer service or healthcare setting required.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%