Claims Resolution Specialist

7 days ago


Alameda, California, United States Boost Healthcare Full time
Job Summary

We are seeking a highly skilled Claims Resolution Specialist to join our team at Boost Healthcare. In this role, you will be responsible for following up on claim status, denials, and initiating appropriate action to resolve insurance balances. You will interact with insurance companies and agencies to resolve unpaid balances and other hospital billing issues.

This position requires excellent communication skills, both written and verbal, as well as the ability to navigate independently through multiple applications, payer portals, and other websites. You must be able to express critical thinking in independent work and demonstrate high capabilities of computer literacy when troubleshooting issues or working with tech support.

Key Responsibilities
  • Completes actions needed for timely claims follow-up and effective appeals submission, including research, rebilling, adjustments, transfers to next responsible parties, and escalating payer issues to Leadership.
  • Corresponds professionally with third-party commercial insurance payers to obtain information required for effective claims resolution.
  • Uses provided reference materials to troubleshoot claims issues and increase understanding of claims resolution techniques, referencing payer websites as needed.
  • Maintains working knowledge of EOBs, EFTs, ERAs, patient liabilities, and insurance or third-party correspondences.
  • Completes assigned work queues or tasks within timeframes assigned by Leadership.
Requirements
  • High school diploma or equivalent.
  • Four years' experience with billing and collections within the health care revenue cycle, including knowledge of HIPAA regulations, diagnosis and procedural codes.
  • Ability to adapt within a high-volume, fast-paced revenue cycle team.
  • Hospital Billing and/or Professional Billing experience.
  • Ability to interpret EOBs, denials, and appeals.
  • Ability to efficiently call insurance payers.
  • Utilize websites and payer portals when applicable.
Salary and Benefits

The salary range for this position is USD $32,670 - $48,330 annually. We offer a comprehensive benefits package, including medical, dental, vision, 401(k) + matching, generous Paid Time Off (PTO) plan, education and wellness stipends, paid holidays, performance-based bonus opportunities, employee referral incentive, and a flexible working environment.

Working Conditions
  • Remote face-to-face trainings and meetings. Cameras are required.
  • Base download/upload internet speed of at least 35Mbps. Satellite/hot spot internet is not permitted.
  • Quiet, dedicated, non-shared, secure space to work.
  • All equipment will be provided by Boost Healthcare.


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