Medical Claims Resolution Specialist
4 days ago
Tri State Urologic Services is a leading healthcare organization in Ohio, committed to delivering exceptional patient care and services. We are currently seeking a highly skilled Medical Claims Resolution Specialist to join our team.
Job SummaryThis is a full-time position responsible for resolving claims submitted to third-party insurance payers. The successful candidate will work closely with the Business Office Supervisor to escalate claim and denial issues, ensuring efficient resolution and meeting productivity targets.
Responsibilities:- Conduct follow-up on no-response third-party receivables, adhering to payer guidelines.
- Review and resolve claim denials, conduct follow-up, appeal processing, and utilize appeals templates as needed.
- Maintain a working knowledge of payer contractual requirements, particularly initial filing periods, follow-up, and appeal protocols.
- Address and resolve issues relating to patient accounts, documenting account actions for audit trail purposes.
- Draft appeal letters as necessary.
- Communicate with Coders, Claim Readiness Specialists, and Business Office staff to resolve errors and clarify issues.
- Ensure adherence to quality and productivity standards, monitoring compliance with policies and procedures.
- Identify process improvement trends and recommend ways to enhance efficiencies.
- Comply with third-party and governmental regulations regarding coding, billing, documentation, compliance, and reimbursement.
- Participate in special projects, personal development training, and cross-training as instructed.
- Inform the Supervisor of trends, inconsistencies, or discrepancies requiring immediate resolution.
The ideal candidate will possess a high school diploma or equivalent and have at least one year of experience in billing or follow-up within a physician's office or medical environment. Experience in a urology physician practice environment is preferred.
Salary and Benefits:We offer a competitive salary range of $45,000 - $65,000 per annum, commensurate with experience. Additionally, we provide a comprehensive benefits package, including health, dental, and vision coverage, 401(k) matching, and paid time off.
About Tri State Urologic ServicesTri State Urologic Services is a top-ranked healthcare organization in Ohio, recognized for its commitment to excellence and patient satisfaction. Our team is dedicated to providing high-quality patient care and services, and we are excited to welcome a new Medical Claims Resolution Specialist to our team.
-
Claims Specialist
5 days ago
Cincinnati, Ohio, United States Total Quality Logistics Full timeAbout the RoleWe are seeking a skilled Claims Specialist to join our team at Total Quality Logistics. As a Claims Specialist, you will play a vital role in our risk management and loss prevention efforts.Key Responsibilities:Research reported claims and determine their validity.Manage the documentation and submission process of each claim in your...
-
Medical Billing Specialist
1 day ago
Cincinnati, Ohio, United States LHH Recruitment Solutions Full timeExciting Opportunity in Medical Billing!LHH Recruitment Solutions is partnering with a reputable healthcare organization in Norwood, OH to find a skilled and motivated Medical Billing Specialist. In this role, you will play a crucial part in managing denied claims, appeals, and denials for physician or hospital claims with both government and commercial...
-
Senior Reinsurance Claims Specialist
5 days ago
Cincinnati, Ohio, United States S&S Healthcare Full timeJob SummaryWe are seeking a highly skilled Senior Reinsurance Claims Specialist to join our team at S&S Healthcare in Cincinnati, Ohio. This role will play a crucial part in managing reinsurance processes, ensuring timely filing of reimbursement claims, and collaborating with multiple departments for accurate processing and documentation.This position...
-
Financial Claims Specialist
5 days ago
Cincinnati, Ohio, United States Great American Insurance Group Full timeJob OverviewThe Great American Insurance Group is seeking a Financial Products Claims Representative to join our team in Cincinnati, OH. As a key member of our Surety Bond Claims team, you will be responsible for investigating and evaluating small to mid-sized commercial surety bond claims.About the RoleThis role requires a high level of technical knowledge...
-
Medical Examiner Specialist
7 days ago
Cincinnati, Ohio, United States MRG Exams Full timeAbout the OpportunityMRG Exams is a leading provider of medical evaluation services in Ohio. We are seeking a Medical Examiner Specialist to join our team as an Independent Medical Evaluator.Job SummaryWe are looking for a highly skilled and board-certified Medical Examiner Specialist with expertise in Occupational Medicine, Physical Medicine & Rehab, or...
-
Medical Revenue Management Specialist
4 days ago
Cincinnati, Ohio, United States LHH Recruitment Solutions Full timeJob OpportunityWe are seeking a highly skilled Medical Biller to manage physician billing operations with dedication and expertise.Responsibilities:Review and process medical bills and claims for accuracy and completeness.Collaborate with healthcare providers to gather essential documentation.Communicate effectively with insurance companies to resolve...
-
Medical Impairment Specialist
7 days ago
Cincinnati, Ohio, United States MRG Exams Full timeCompany OverviewMRG Exams is a leading provider of Independent Medical Evaluations (IME) and Permanent Partial Impairment Ratings (PPIR) services for the Ohio Bureau of Workers' Compensation (BWC), third-party administrators, Managed Care Organizations (MCOs), and employers.Estimated Salary Range$180,000 - $220,000 per year, depending on experience and...
-
Medical Imaging Specialist
7 days ago
Cincinnati, Ohio, United States Aureus Medical Group - Imaging Full timeAureus Medical Group - Imaging is a leading provider of healthcare professionals, and we are seeking a highly skilled Medical Imaging Specialist to join our team. This role offers the opportunity to work in a dynamic hospital setting, utilizing your expertise in Radiography to deliver exceptional patient care.We are offering a competitive salary package,...
-
Medical Coding Specialist
5 days ago
Cincinnati, Ohio, United States Cincinnati Children's Hospital Medical Center Full timeAccurate Medical Coding and Data AnalysisWe are seeking a highly skilled Medical Coding Specialist to join our team at Cincinnati Children's Hospital Medical Center. This role will play a vital part in ensuring accurate and compliant coding of medical records related to trauma cases.Job Description:Manage customer/vendor relationships by building and...
-
Cincinnati, Ohio, United States MRG Exams Full timeMRG Exams is a leading provider of medical services for the Ohio Bureau of Workers' Compensation, third-party administrators, and employers. We are seeking dedicated and board-certified physicians to join our team as Independent Medical Evaluators.This is an exceptional opportunity for both seasoned providers and those looking to embark on a rewarding...
-
Medical Device Specialist
6 days ago
Cincinnati, Ohio, United States Sequel Medical Technology Full timeOverview of Sequel Medical TechnologySequel Medical Technology is an innovative company dedicated to developing cutting-edge precision drug delivery devices. As a pioneer in this field, we strive to revolutionize the treatment of diabetes.About the RoleWe are seeking a highly skilled Medical Device Specialist - Diabetes Education to join our team. This role...
-
Cincinnati, Ohio, United States MRG Exams Full timeAs a medical professional, you have the opportunity to excel in a unique field that combines expertise in medicine with critical thinking and evaluation skills. MRG Exams is seeking Board-certified MDs or DOs in Occupational Medicine, Physical Medicine & Rehab, or Orthopedics to join our team as Independent Medical Evaluators (IME).About the PositionThis...
-
Occupational Medicine Specialist
1 day ago
Cincinnati, Ohio, United States MRG Exams Full timeJob Opportunity:We are seeking a dedicated and board-certified MD or DO in Occupational Medicine, Physical Medicine & Rehab, or Orthopedics to conduct comprehensive medical assessments, evaluate permanent partial impairment, and provide objective opinions for claims adjudication and case management.About the Role:This is an exceptional opportunity for...
-
Medical Assistant Specialist
5 days ago
Cincinnati, Ohio, United States Beacon Orthopaedic Partners MSO LLC Full timeJob Title: Medical Assistant SpecialistWe are seeking a highly skilled and dedicated Medical Assistant Specialist to join our team at Beacon Orthopaedic Partners MSO LLC. As a key member of our surgical staff, you will play a vital role in ensuring the highest level of patient care and satisfaction.About the JobThe Medical Assistant Specialist is responsible...
-
Medical Impairment Evaluator
3 days ago
Cincinnati, Ohio, United States MRG Exams Full timeOverview:">MRG Exams, a leading provider of Independent Medical Evaluations (IME) and Permanent Partial Impairment Ratings (PPIR) services in Ohio, is seeking dedicated and board-certified MDs or DOs, licensed Psychologists, and Psychiatrists to join our team as an IME Specialist.">Job Summary:">We are looking for experienced professionals who can conduct...
-
Medical Imaging Specialist
5 days ago
Cincinnati, Ohio, United States Healthcare Support Full timeRole OverviewWe are seeking a skilled Medical Imaging Specialist to join our team in Cincinnati, Ohio.About the RoleThis is a 13-week contract opportunity that requires a strong background in radiology and allied health professions. As a Medical Imaging Specialist, you will be responsible for capturing high-quality images using advanced medical equipment....
-
Cincinnati, Ohio, United States Aureus Medical Group - Imaging Full timeAureus Medical Group - Imaging is seeking a highly skilled medical imaging specialist to join their team in Cincinnati, Ohio. This role offers a unique opportunity to work with cardiovascular patients and contribute to the success of the organization.Job OverviewThis position involves working as an Interventional Radiology Technologist, utilizing advanced...
-
Geriatric Medical Specialist
7 days ago
Cincinnati, Ohio, United States Abode Care Partners Full timeJob OverviewWe are seeking a skilled Geriatric Medical Specialist to provide high-quality medical care to seniors and patients with complex needs in various settings.
-
Medical Equipment Specialist
7 days ago
Cincinnati, Ohio, United States Prolink Full timeWe are seeking a highly skilled Medical Equipment Specialist to join our team at Prolink. This is an exciting opportunity for individuals who enjoy working in a fast-paced environment and are passionate about maintaining medical equipment.Estimated Salary:$73,000 - $83,000 per year, depending on experienceAbout the Role:The Medical Equipment Specialist will...
-
Medication Aide Specialist
6 days ago
Cincinnati, Ohio, United States Caring Place Healthcare Group Full timeCaring Place Healthcare Group is a family-owned and operated nursing and rehabilitation center, located in Cincinnati. We are seeking a Medication Aide Specialist to join our team on night shifts from 7pm to 7am, full-time. The successful candidate will be eligible for the following benefits: 3 different health insurance plans with access to 4 local Marathon...