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Claims Resolution Specialist

2 months ago

Atlanta Georgia, United States Northside Hospital Inc. Full time
Job Summary

Northside Hospital Inc. is seeking a highly skilled Claims Resolution Specialist to join our team. As a Claims Resolution Specialist, you will be responsible for resolving denied claims and ensuring timely payment from insurance carriers.

Key Responsibilities
  • Draft and submit written letters of appeal to insurance carriers for denied claims.
  • Utilize contract summaries to verify balances due on disputed claims and negotiate reimbursement requirements.
  • Review account information from various sources, including online data, hard copy reports, and EOBs, to discuss account conditions with payers.
  • Refers accounts to appropriate departments for necessary action, such as balance transfers, electronic billing, and audit reviews.
  • Maintains accurate system documentation with notes and standard note codes for extraction of denial data from the Denial database.
  • Notifies Supervisor of payor trends in denied accounts.
Requirements
  • Bachelor's degree in Health Science, Bookkeeping, or Business, or equivalent college courses, plus 3 years of insurance collections/AR receivables experience.
  • Associate's degree, plus 4 years of experience in healthcare receivables or a related field.
  • 5 years of experience in healthcare receivables or a related field.
  • Knowledge of healthcare receivables and collections, including denial and appeal processes.
  • Good verbal and written communication skills.
  • Proficient calculator experience.
Preferred Qualifications
  • CPAR certification.
  • Knowledge and experience with Excel.
  • Experience with STAR, McKesson products.