Job description
Integra is seeking a results-oriented, dynamic, proven Claims Examiner, with a specific background in the complex rehab technology (CRT) space. This role is responsible for real time support of helping our key CRT providers navigate the complexities of their billing with our payers, and both our Network and Claim’s teams.
The ideal candidate thrives by collaborating with multiple entities in and outside of Integra to solve challenges. The individual must be skilled in problem solving and managing processes, with an attitude that exemplifies high energy and a passion for the healthcare business. To succeed, the individual will need to be effective driving results through and with teams.
Salary: $70,000/Annually
Responsibilities and Duties
- Be prepared to appeal or correct CRT claims in compliance with Medicare, Medicaid, and commercial insurance guidelines.
- Ensure all required documentation (e.g., prescriptions, prior authorizations, therapist evaluations, and medical necessity justifications) is included with claims.
- Verify coding accuracy, including HCPCS codes, modifiers, and pricing structures for CRT equipment.
- Track and monitor outstanding claims, identifying and resolving denials or underpayments.
- Communicate with Payer Team to address rejections, request re-considerations, and appeal denied claims as necessary.
- Work closely with internal teams to obtain missing documentation or clarify coding and billing discrepancies.
- Analyze claim’s files from CRT providers and effectively communicate trends or challenges to provider and internal teams..
- Maintain up-to-date knowledge of payer policies, Medicare/Medicaid requirements, and regulatory changes affecting CRT reimbursement.
- Ensure claims processing adheres to HIPAA regulations and payer-specific guidelines.
- Document claim activity and payer communications in the claims management system.
- Assist providers and patients with claim-related inquiries, explaining coverage and reimbursement status.
- Join provider calls and give proper guidance around documentation and claims submission best practices to reduce denials.
What will you learn in the first 6 months?
- In the first six months you will learn the function of the Network Team within the organization and be fully integrated in your position, company, and team
- You will have a full and complete understanding of our metric requirements and reporting capabilities
- You will understand your role and responsibilities, to foster excellence in team performance
- You will develop team goals and monitor progress, as you build relationships with your team to encourage and understand their needs and abilities
- During this time, you will set measurable goals for personal development and growth
What will you achieve in the first 12 months?
- You will create a people first approach to your team, easily identifying the strengths and weakness of each team member and how to best support them
- You will be contributing your skills and knowledge to meet your department’s metrics and goals
- You will have regular monthly one-on-one meetings with your Director for mutual feedback and establish strategies for development
Knowledge/Skills/Abilities
- 5+ years of experience in medical claims processing, billing, or revenue cycle management.
- Knowledge of DME and complex rehab technology (CRT) billing, including Medicare, Medicaid, and commercial payer rules.
- Experience with HCPCS coding, modifiers, and medical necessity documentation for CRT products.
- Strong understanding of insurance verification, prior authorization, and appeal processes.
- Proficiency in claims management systems and electronic billing platforms.
- Excellent attention to detail, problem-solving, and organizational skills.
- Certification in medical billing and coding (e.g., CPC, CPB, CRCS).
- Prior experience working for a CRT provider, DME supplier, or payer specializing in rehab technology.
- Familiarity with payer portals and electronic remittance advice (ERA) processing.
- Ability to analyze and resolve claim denials efficiently.
- Strong written and verbal communication skills.
- Capacity to work independently while collaborating with cross-functional teams.
- Adaptability to changing payer policies and regulatory requirements.
Benefits Offered
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage (location restrictions may apply)
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We are reimagining access to in-home healthcare to improve the quality of life for the communities we serve.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
