Claims Clearinghouse Processing Representative

TeamHealth is named among the Top 150 Places to Work in Healthcare by Becker's Hospital Review. Newsweek Magazine recognizes TeamHealth as ‘one of the greatest workplaces for diversity, 2024’ and TeamHealth is also ranked as ‘The World’s Most Admired Companies’ by Fortune Magazine. TeamHealth, an established healthcare organization is physician-led and patient focused. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us. What we Offer:

Career Growth Opportunities

Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment 401K (Discretionary matching funds available) Generous PTO 8 Paid Holidays Equipment Provided for Remote Roles Overview: The Clearinghouse Representative serves as a key liaison between the Billing Centers and the Clearinghouse, providing essential support to ensure efficient and accurate claims processing. This role is responsible for facilitating communication, resolving issues, and supporting various operational workflows related to claims management and electronic data interchange (EDI). KEY RESPONSIBILITIES:

• Serve as the primary point of contact between Billing Centers and the Clearinghouse.
• Support the onboarding and maintenance of Claims and Remittance Enrollment.
• Oversee Workgroup Management activities to ensure proper routing and handling of transactions.
• Assist in managing Denials and Appeals processes to help reduce outstanding accounts receivable.
• Support EOB Conversion processes
• Monitor Claim Submission and Rejection Trends
• Fulfill additional tasks and projects as assigned to support operational goals.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Conducts thorough research and system analysis to resolve issues reported by Billing Centers, providing solutions that improve system integrity and workflow.
• Facilitates communication and collaboration with internal departments—such as Applications staff—and external Billing Centers to support efficient resolution of requests and project needs.
• Partners with vendors (e.g., Waystar) to ensure accurate and timely resolution of system- or process-related issues.
• Provides oversight and support for the OnBase application, assisting Billing Centers with enhancements and issue resolution.
• Confirms daily transmission of claims from TeamHealth to Waystar.
• Reviews Waystar Workgroups on a daily basis to ensure:
• Front-end claim rejections are triaged to the appropriate party or routed for enrollment as needed.
• Claims are actively progressing through each workgroup.
• Completes claims and remittance enrollments as submitted by Billing Centers.
• Maintains and distributes key Waystar reports, including:
• ZirMed Enrollment 205 Edit Report – Weekly
• ERA Opportunities / New Business Report – Weekly
• Waystar Invoice Reconciliation – Monthly
• Performs other duties as assigned to support departmental goals and efficiency.

QUALIFICATIONS / EXPERIENCE:

• Demonstrated comprehensive understanding of the duties and responsibilities required for the position.
• Strong working knowledge of the IDX Billing System, including related billing and accounts receivable functions.
• Extensive background in medical billing, including knowledge of reimbursement processes, payment posting, and healthcare billing systems.
• Proven analytical skills, with the ability to assess data, identify trends, interpret findings, and make informed decisions.
• Effective written and verbal communication skills, with the ability to collaborate across departments and with external vendors.
• Experience conducting research and systems analysis to resolve reported issues and recommend solutions that uphold system integrity.
• Proficient in Microsoft Office applications, particularly Excel and Word.

EDUCATION: A bachelor’s degree in Information Systems or a related field is preferred. Equivalent relevant work experience may be considered in lieu of a formal degree. Apply tot his job Apply To this Job