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Claims Specialist
Claims SpecialistQuadrant Health Group • Boca Raton, FL, US
Claims Specialist

Claims Specialist

Quadrant Health Group • Boca Raton, FL, US
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

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

    PI7cea70d8db1f-37476-38267920

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