Claims Specialist

Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, i s seeking a passionate and dedicated Claims Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively.

Why Join Quadrant Health Group?

• Competitive salary commensurate with experience.
• Comprehensive benefits package, including medical, dental, and vision insurance.
• Paid time off, sick time and holidays.
• Opportunities for professional development and growth.
• A supportive and collaborative work environment.
• A chance to make a meaningful impact on the lives of our clients.

Compensation: $18 - $24 per hour - Full-time

What You'll Do:

The ideal candidate is organized, persistent, and results-driven, with deep knowledge of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You’ll join a high-performing team focused on maximizing collections, reducing aging A/R, and ensuring every dollar is pursued.

Major Tasks, Duties and Responsibilities:

• Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care.
• Manage 500–700 claims per week , prioritizing efficiency and accuracy.
• Handle 4–5 hours of phone time per day with strong communication skills.
• Communicate with payers via phone, portals, and written correspondence to resolve billing issues.
• Identify trends in denials and underpayments and escalate systemic issues.
• Dispute and overturn wrongly denied claims .
• Update and track claims using CMD (CollaborateMD) and internal task systems.
• Follow QBS workflows using Google Drive, Docs, Sheets, and Kipu EMR .
• Maintain professional and timely communication with internal teams and facility partners.

Bonus Experience (Not Required):

• Handling refund requests and appeals .
• Preparing and submitting level 1–3 appeals (e.g., medical necessity, low pay, timely filing).
• Gathering and submitting medical records for appeal support.
• Working with utilization review (UR) or clinical teams.
• Familiarity with ASAM and MCG medical necessity criteria .
• Exposure to payment posting, authorization reviews , or credentialing .

What You'll Bring:

• Minimum 1 year of SUD/MH billing and claims follow-up experience (required).
• High School Diploma or equivalent, associate or bachelor’s degree (preferred).
• Strong understanding of insurance verification, EOBs, and RCM workflows .
• Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest .
• Experience overturning insurance denials is a strong plus .
• Proficient in CMD (CollaborateMD) and Kipu EMR (strongly preferred).
• Excellent written and verbal communication skills.
• Highly organized, detail-oriented, and capable of managing multiple priorities.

Why Join Quadrant Billing Solutions?

• Rapid career growth in a mission-driven, niche billing company.
• Collaborate with clinical and billing experts who understand behavioral health.
• Join a tight-knit, supportive team culture.
• Gain opportunities for leadership advancement as the company scales.

#HP

Compensation details: 18-24 Hourly Wage

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