[Hiring] Insurance Guideline & Compliance Specialist @Arietis Health

At Arietis Health, we recognize the vital role healthcare revenue cycle plays in maintaining the well-being of individuals and businesses alike. Our commitment is to demystify healthcare billing by empowering individuals and collaborating with premier healthcare organizations to address their executives' most pressing revenue cycle challenges. By doing so, we enable them to shift their focus towards providing exceptional patient care. Grounded in the belief of harnessing the expertise of a highly skilled team and advanced technology, we strive to cultivate a seamless patient billing experience that not only excels in efficiency but also delivers superior results. Join us in achieving our mission. We're actively seeking an Insurance Guideline & Compliance Specialist to join our fast-growing team. If you're eager to contribute to redefining the landscape of healthcare revenue cycle management and be a part of our collaborative, positive, and human-centric culture, we'd love to hear from you! About the Position: The Insurance Guideline & Compliance Specialist is a meticulous, detail-oriented professional responsible for researching, interpreting, and communicating complex insurance guidelines and government regulations (Medicare, Medicaid, commercial payers) to ensure the timely and accurate submission and reimbursement of claims. This role is vital to maintain regulatory compliance, minimizing claim denials, and optimizing the company's revenue cycle. What You’ll Do: • Guideline Research and Communication: Proactively research and analyze updates to federal, state, and commercial insurance payer rules, medical policies, and billing regulations (e.g., CMS, AMA guidelines for CPT/ICD coding). • Subscribe to and monitor all communication from a payor via Listserv platforms for specialties relevant to client’s scope of services. • Documentation and Communication: Document and translate complex insurance guidelines into clear, actionable summaries for appropriate stakeholders. Maintain all research within designated shared files for use within the company. • Issue Resolution & Appeals: Investigate and resolve complex claim denials, underpayments, and discrepancies by applying relevant coverage rules and preparing detailed appeal letters and documentation. • Training & Support: Collaborate with the internal teams serve as a subject matter expert on insurance requirements and related billing changes. • Ensure adherence to CMS, NCQA, HIPAA, and payer-specific regulations. • Perform other duties as assigned. • Adherence to the Code of Conduct and Corporate Compliance Program What You’ll Bring: • Bachelor’s degree in business or health care administration required, or a related field (or equivalent experience). • Minimum of 2-4 years of experience in medical/insurance billing, claims processing, or compliance is required. • Proven experience researching and interpreting insurance policies and governmental regulations. • Proficiency in medical billing software and Electronic Health Record (EHR) systems. • Strong working knowledge of medical terminology and coding structures (CPT, ICD-10, HCPCS). • Expertise in accessing and utilizing various insurance carrier portals for information. • Exceptional attention to detail and strong analytical and problem-solving abilities. • Excellent written and verbal communication skills for interacting with insurance payers, medical staff, and internal teams. • Ability to work independently and manage multiple priorities in a fast-paced, dynamic environment. • Possess strong organizational skills. • Understand HIPAA (Health Insurance Portability and Accountability) guidelines. • Strong Language Ability: Read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Write routine reports and correspondence. Speak effectively before groups of customers or employees. • Strong Mathematical Ability: Calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Apply concepts of basic algebra and geometry. • Strong Reasoning Ability: Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Interpret a variety of instructions furnished in written, oral, diagram, or schedule form. • Excellent technical writing capability • Excellent non-technical writing capability • Excellent telephone skills and manner with customers • Excellent face-to-face interactions with customers • Excellent organizational skills • Excellent process development and documentation skills • Preferred Certifications • Certified Professional Biller (CPB) • Certified Professional Coder (CPC) • Certification in Healthcare Compliance (CHC) What We Offer: A chance to simplify revenue cycle management, together at a high-growth company! Since our founding in 2020, we’re already helping millions of patients and thousands of providers each year. We are proud to offer: • Competitive compensation • 401K plan with company match • PTO with 12 additional paid holidays • Telehealth at no cost to employees • Health, dental, vision, and prescription drug coverage • Group life insurance, Optional Life, Critical Illness and more. • Training, development, and mentorship opportunities Other: • Our commitment to fostering a diverse and inclusive workplace is unwavering. All qualified applicants will be considered for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status. • The job description provided above is not an exhaustive list of duties and standards for the position. Incumbents are encouraged to willingly embrace additional instructions and undertake related duties as assigned by their supervisor. • As a condition of employment, you are expected to adhere to established compliance program requirements and uphold the employee and internet codes of conduct outlined in the Employee Handbook. • While all tasks and responsibilities listed are considered essential functions of this position, we recognize that business conditions may require reasonable accommodations for additional tasks and responsibilities. • The work environment characteristics outlined herein represent those encountered by an employee while performing the essential functions of this job. Reasonable accommodation may be arranged to facilitate individuals with disabilities in fulfilling these essential functions. • The physical requirements outlined herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. We are dedicated to making reasonable accommodations to enable individuals with disabilities to fulfill these essential functions. Apply tot his job