Senior Claims Specialist

Senior Claims Specialist

Hybrid in West Bloomfield, MI

Metro Vein Centers

Healthy legs feel better.

Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. Our industry-leading team of board-certified physicians is on a mission to meaningfully improve people?s quality of life by relieving the often painful and highly treatable symptoms of vein disease?such as varicose veins and heavy, aching, swollen legs. We currently operate 50+ clinics throughout 7 states with a vision of becoming the go-to vein care choice for patients nationwide.

Metro Vein Centers At-A-Glance

Welcome to vein care done differently.
? We?re the fastest growing vein practice in the US?celebrating more successful organic expansion than our top 5 competitors combined.
? Our proven capital-efficient, de novo growth strategy has enabled us to open 30+ clinics in the last two years, funded entirely through positive cash-flow.
? Our differentiated brand and sophisticated digital marketing strategy fuels our rapid expansion.
? Our physicians are empowered to solely focus on patient-care, with full admin and clinical staff support, marketing and patient experience best practices, and end-to-end Revenue Cycle Management all powered by Metro Vein Centers HQ.
? We proudly maintain both a best-in-class physician retention rate and an NPS of 93 across 150,000 annual patient visits?the highest patient satisfaction in the industry.

How You?ll Make a Difference:

Metro Vein Centers (MVC) is seeking a highly skilled and detail-oriented Senior Claims Specialist to join our Revenue Cycle Department. This position plays a critical role in optimizing the claims management process, ensuring compliance, and enhancing operational efficiency. The Senior Claims Specialist will handle escalated claims, audit the performance of Accounts Receivable (AR) vendor partners and MVC staff, investigate denial trends to identify root causes, and develop standard operating procedures (SOPs) to drive process improvements. The ideal candidate will serve as a pivotal resource in identifying opportunities for streamlining workflows and reducing inefficiencies within the claims process. This role requires a proactive problem-solver who can collaborate across departments to implement effective solutions. Additionally, the Senior Claims Specialist will be instrumental in mentoring team members and fostering a culture of continuous improvement within the Revenue Cycle Department.
? Review and resolve escalated claims, including high-complexity or high-dollar claims, ensuring accuracy, timeliness, and compliance with payer guidelines in a multistate practice. .
? Analyze denied or underpaid claims to identify patterns and root causes, providing actionable recommendations to reduce future denials.
? Audit AR vendor partner performance and internal staff processes to ensure compliance with MVC standards and contractual obligations.
? Create, document, and implement SOPs for claims processing, denial management, and AR follow-up to improve efficiency and reduce errors.
? Monitor and report on denial trends, preparing detailed performance reports and dashboards for leadership.
? Work closely with payers to facilitate appeals and expedite resolution of complex claims.
? Stay current with payer policies, coding updates, and regulatory changes affecting claims and reimbursement, sharing knowledge with the team.
? Provide training and mentorship to staff on claims processes, payer guidelines, and best practices to enhance team capabilities.
? Partner with Patient Financial Services Supervisor on special projects.

Competencies
? In-depth knowledge of insurance claims processing, denial management, and payer policies.
? Strong analytical skills with the ability to identify trends and implement corrective measures.
? Proficiency in healthcare billing software (e.g., AthenaHealth), Google Workspace (Sheets, Slides, Docs, etc) or Microsoft Office (Excel, Powerpoint, Word).
? Excellent organizational, communication, and problem-solving skills.
? Ability to handle sensitive and confidential information with professionalism.
? Experience developing and implementing SOPs and process improvement initiatives.
? Skilled in developing and implementing training programs and SOPs to drive continuous improvement, reduce operational inefficiencies, and ensure audit readiness.
? Strong leadership and collaboration skills, with experience working with both onshore and offshore teams, fostering a culture of accountability and continuous learning.
? Capable of identifying revenue leakage points and implementing corrective actions to improve cash flow and overall financial performance.

Required education and experience
? High School Diploma or equivalent
? Minimum of 3 years of experience in physician claims management (CMS-1500), revenue cycle operations, or a related role.

Preferred education and experience
? Experience with Athena Practice
? Experience working with a multistate medical practice
? Experience developing and implementing SOPs and process improvement initiatives.
? Experience working with RCM vendors: onshore or offshore

Job Type: Full-time

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