About Our Company

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians .

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Job Description

Join VillageMD as a Medical Claims Specialist (REMOTE)

WHY VILLAGEMD

At VillageMD, we're looking for a Medical Claims Specialist to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best Primary Care Physicians and Advanced Practice Providers. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

OUR CULTURE AND VALUES

VillageMD is a group of collaborative, entrepreneurial and smart people who are united in our goal to improve primary care, making a difference in people's lives.

Get Stuff Done: We roll-up our sleeves and dive into the details, tackling the work at hand with infectious enthusiasm. We’re highly accountable for our work and the value we add, inspiring others with our constant ability to deliver results. No challenge is too small or too big.

Build Trust: We are humbled by those we serve and the importance of our vision. We invest in relationships with open and honest conversation seeking personal connections. We show respect for others in our words and actions. We do what we say we are going to do. We are knowledgeable, but always take the time to listen and learn.

Innovate: Our curiosity is endless, and challenging the status quo is a priority. New approaches are rewarded and we are always seeking to improve. We know that changing healthcare is hard, and we embrace the challenge.

COULD THIS BE YOU

As a Medical Claims Specialist, this role is responsible for researching and processing institutional and professional claims while providing subject matter expertise to departmental and corporate projects. This role analyzes and performs root cause analysis on all types of claims issues and adjustments and serve as a primary point of contact to resolve issues requiring any and all other departments outside of Claims.

How You Will Get Things Done:

• Process claims that pend for various hold reasons to assist in the final determination on claim disposition
• Process adjustments related to projects or provider disputes providing timely follow-up provider call backs
• Support business definition and testing efforts, attend project meetings, maintain project plans and provide internal and external status reports
• Research complex claims issues and work with other departments to resolve
• Research issues, compile feedback and draft corresponding business requirements documents and business decision documents as needed
• Perform special projects as assigned

How You Will Build Trust:

• Act as Claims Department subject matter expert on departmental and corporate projects
• Serve as primary liaison to all external departments, markets, and providers on claims related content
• Communicate changes in processes, project status and issue resolutions through email, memos, group presentations, and/or individual one-off meetings

How You Will Innovate:

• Works with management and associates to document current business and workflow processes and collaborates in identifying, defining and documenting process improvement options and alternatives
• Analyzes and trends claims issues, performs true root cause analysis and determines next steps for resolution and process improvement

EXPERIENCE TO DRIVE CHANGE

• High school diploma or equivalent is required
• 5+ years of experience in claims processing commercial and Medicare claims
• 3+ years of knowledge and experience in researching and resolving operational issues
• EZ-CAP software experience is highly preferred
• Previous visibility into Medicare and Medicare Advantage programs is a highly preferred

For Colorado Residents only: The base compensation range for this role is $20.80 to $25.00. At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc. This role may be eligible for annual/quarterly bonus incentives (if applicable), and the selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan with company match.

About Our Commitment

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities ( EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/ .