Claims Resolution Specialist
4 weeks ago
Overview: Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.
- Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years.
- Conduct AR Follow-up both on front end scrubs and back end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
- Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
- Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
- Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
- Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
- Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
- Candidate must be able to report and communicate issues and trends.
- Meet or exceed daily productivity benchmarks.
Knowledge, Skill, and Experience Requirements:
- 3+ years of experience in claims resolution or medical billing.
- A minimum of 3 years of documented experience on the Athena billing platform is required.
- Working knowledge of CPT, ICD-10, and medical terminology.
- Complete understanding of follow-up processes.
- Solid background in AR and overall Revenue Cycle policies and procedures.
- Experience working in a physician billing environment.
- Excellent communication skills.
- Proficiency in Microsoft Office Suite, including Word and Excel.
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