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Healthcare Claims Resolution Specialist

2 months ago

Springfield, Missouri, United States CenterWell Home Health Full time

About the Role:

As a Healthcare Claims Resolution Specialist at CenterWell Home Health, you will play a critical role in ensuring the timely and accurate reimbursement of healthcare claims. Your expertise will be instrumental in resolving claim denials, analyzing accounts receivable, and guiding agency personnel in insurance and non-Medicare claims processing.

Key Responsibilities:

  • Coordinate claim activities and designated agencies to ensure timely reimbursement of receivables.
  • Research, resolve, and prepare claims that have not passed payer edits daily.
  • Determine and initiate action to resolve rejected invoices.
  • Analyze each agency's outstanding monthly accounts receivable and process claims to obtain zero balances.
  • Clear payment variances, resolving differences, and initiating corrective action.
  • Guide and support agency personnel in all aspects of insurance and non-Medicare claims processing.
  • Prepare input data forms to update computer systems.
  • Review and communicate with agencies to educate them about expectations for clean claims.

Requirements:

  • High School Diploma or equivalent.
  • Minimum of two years medical claims processing experience.
  • Knowledge of healthcare collection procedures and microcomputer software/hardware.
  • Effective analytical and communication skills.

Benefits:

CenterWell Home Health offers a competitive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and opportunities for professional growth and development.