Job description
About Carda
Carda Health is building the world’s first patient-centered virtual heart clinic. We started with cardiac rehab because only 10% of qualifying Americans attend, resulting in complications for patients and at least $190B in costs to the US health system. Our leading heart rehab clinic allows patients to complete engaging, compassionate, and life-saving care from home. We now work with some of America’s largest and top-ranked hospitals and most innovative insurers. We are fortunate to be backed by some of the best investors in the business who have also backed the likes of Livongo, Mammoth Biosciences, and Ro to name a few.
Carda is a team of clinicians, mathematicians, repeat entrepreneurs, and engineers. And one recovering financier. Our united belief is that technology and data, when applied ethically and compassionately, can transform individuals’ lives and fundamentally change even the most entrenched industries. Carda was founded by Harry and Andrew, two friends from Wharton who share a family history of heart disease and personal experience with cardiac rehab.
Who are you?
You are meticulous, detail-oriented, and driven by accuracy. You find satisfaction in identifying and resolving discrepancies that others might miss. You are passionate about healthcare administration and understand how proper claims processing directly impacts patient care and company success. If you exhibit one characteristic above all others, it is thoroughness. It personally bothers you when errors slip through and you do everything in your power to prevent this from happening. You are a great collaborator who can effectively communicate complex billing issues to both clinical and administrative teams. You thrive under pressure and can maintain exceptional attention to detail even when working with high volumes. You are able to identify patterns and suggest process improvements that increase efficiency and accuracy.
What will you do?
As our Claim Review Specialist, you will own and improve our claims review process to ensure maximum reimbursement and compliance. You will be a crucial member of our revenue cycle team working collaboratively with clinical and administrative staff to make Carda Health’s billing process a model of efficiency and accuracy. We are looking for someone who is passionate about healthcare finance and excited to jump in and make an impact. This role will work cross-functionally with our clinical, finance, and compliance teams to ensure claims are processed correctly the first time, thereby helping Carda transform patient lives while maintaining financial sustainability!
In a little more detail:
- Reviewing medical claims before submission to identify and correct errors
- Ensuring claims meet payer-specific requirements and billing guidelines
- Verifying proper coding (CPT, ICD-10, HCPCS) on claims
- Checking for missing information or documentation
- Identifying potential claim denials before submission
- Correcting claim errors or returning them to appropriate staff for correction
- Monitoring claim rejection patterns and implementing process improvements
- Staying current with insurance requirements and coding regulations
- Communicating with providers and billing staff about documentation needs
- Maintaining high accuracy rates for clean claim submissions
What we look for:
Ability to work during a United States time zone
2+ years of experience in healthcare claims processing or medical billing with a track record of improving clean claim rates
Strong knowledge of CPT, ICD-10, and HCPCS coding
Experience with insurance verification and prior authorization processes
Ability to work in a fast-paced environment with changing priorities
Highly collaborative and excellent written and oral communication skills. It is imperative you are able to clearly and effectively interact with members of our team in a remote environment.
Inherent growth mindset: you are always focused on improving faster and getting the team to do the same
Ability to track and report on key metrics that define your success including clean claim rate, denial rate, and days in A/R
Nice to haves:
Certification in medical coding (CPC, CCS, etc.)
Experience with virtual or telemedicine billing
Experience with cardiac care or rehabilitation billing
Experience and desire to work remotely (our whole team is remote)
Prior experience using technology tools including GSuite, electronic health records, and claims processing software
Experience and desire to work remotely (our whole team is remote)
Prior experience using technology tools including GSuite, ZenDesk, Slack
