Medical Claims Resolution Specialist

4 days ago


Cincinnati, Ohio, United States Tri State Urologic Services Full time
About the Role

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 Summary

This 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.
Requirements:

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 Services

Tri 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.


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