Claims Resolution Specialist

1 day ago


Charlotte, North Carolina, United States Medix Full time
Job Opportunity

We are seeking a skilled Claims Resolution Specialist to join our team at Medix.

Salary: $55,000 - $65,000 per annum, depending on experience.

About the Role

This is a full-time position that involves working in a fast-paced environment to resolve healthcare claims issues for our clients. As a Claims Resolution Specialist, you will be responsible for providing excellent customer service, communicating effectively with various stakeholders, and resolving claim-related concerns in a timely manner.

The ideal candidate will have previous experience in claims management, preferably within a hospital or large provider group setting. They will also possess strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills.

Responsibilities
  • Provide effective and timely customer service to members, providers, insurers, and clients regarding healthcare claims
  • Ensure timely follow-up on requests for account reviews
  • Organize health insurance paperwork and medical record documentation
  • Demonstrate knowledge of proprietary software and other required technology
  • Negotiate with providers on plan member balances
  • Challenge denials of claims by the insurance company
  • Communicate with medical offices, hospitals, laboratories, etc., to obtain relevant records for patient cases
  • Contact providers and insurance companies to resolve claim concerns
  • Assist with understanding explanation of benefits (EOBs)
Requirements
  • 1+ years of claims experience within a hospital or large provider group setting (10+ providers)
  • 2+ years of Healthcare Collections and A/R experience
  • Possession of medical billing/coding certification (CPC) is beneficial but not required
  • College degree preferred, but additional experience may be considered in lieu of a college degree
Benefits

We offer a competitive salary and a comprehensive benefits package, including:

  • Minimum Essential Coverage (MEC) plan
  • Two different fixed indemnity plan add-ons
  • Major Medical Plans, including 1 HSA Plan
  • Dental
  • Vision
  • Short-term disability
  • Life and AD&D


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