Overview
6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy. We are currently seeking a Payment Integrity Claims Specialist to join our fun, fast-paced environment.
Role Summary
The Payment Integrity Claims Specialist is responsible for reviewing and managing complex, high-dollar medical claims to ensure accuracy, completeness, and compliance. This role supports the clinical and claims teams through detailed analysis and workflow management to deliver timely, high-quality results for our clients.
Essential Role Responsibilities
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Review high-dollar claims and UB-04 forms for accuracy and completeness.
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Obtain and verify missing information as needed.
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Support the clinical department with claims routing, finalization, workflow tracking, and documentation management.
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Monitor and process incoming and outgoing electronic claims via Fennec.
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Enter manual claims into Fennec and manage uploads from multiple clients to the secure server.
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Send provider and client communication preferences to Account Managers.
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Research and resolve claim inquiries or route them to the appropriate team members.
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Collaborate with internal teams to identify process gaps and recommend improvements.
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Maintain accurate claim records.
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Exercise discretion and independent judgment in responding to provider appeals and correspondence.
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Participate in special projects and perform other duties as assigned.
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Other responsibilities or projects as assigned
Essential Role Functions
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Must have the ability to read and understand various process flows and procedures
- Strong internal and external communication skills, both verbal and written
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Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
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Must be able to sit or stand for two hours at a time
- Must be able to operate computers and phones to support position requirements
Minimum Role Requirements
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Associate degree or higher preferred
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3-5 years of healthcare experience preferred
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Proficiency in Microsoft suite including Excel, Word, Visio and PowerPoint
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Excellent verbal and written communication skills
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Strong ability to read and understand process flows and procedures.
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Detail-oriented with strong organizational and problem-solving skills
Organizational Benefits
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Medical, Dental, Vision and Other Outstanding Ancillary Benefits
- Training and Development Opportunities
- 10 Paid Holidays
- 401(k) Program with 3% Employer Match
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Monthly Remote Work Stipend
- Unlimited Paid Time Off
Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa.
The base salary range for this position is between $52,000 and $62,000 plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location.
At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas.
6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.
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