Claims Resolution Specialist
2 weeks ago
Tri State Urologic Services is seeking a highly skilled Claims Resolution Specialist to join our team. As a Claims Resolution Specialist, you will be responsible for following up and resolving claims submitted to third-party insurance payers.
Key Responsibilities:- Conduct follow-up on no-response third-party receivables in accordance with payer guidelines.
- Review and resolve claim denials, conduct follow-up, appeals processing, and claim statusing using appeals templates when necessary.
- Develop and maintain a working knowledge of payer contractual requirements, particularly initial filing periods, appropriate follow-up, and appeal protocols.
- Address and resolve issues relating to patient accounts while noting account actions for complete audit trails of follow-up activity.
- Draft appeal letters as necessary.
- Communicate with Coders, Claim Readiness Specialists, and Business Office staff when necessary to resolve errors and clarify issues.
- Stay accountable to quality and productivity standards and monitor compliance with policies and procedures.
- Identify process opportunity trends and recommend ways to improve efficiencies.
- Ensure adherence to third-party and governmental regulations relating to coding, billing, documentation, compliance, and reimbursement.
- Participate in special projects, personal development training, and cross-training as instructed.
- Inform Supervisor of trends, inconsistencies, discrepancies for immediate resolution.
- Work in conjunction with peers and functional areas of the Business Office department for the betterment of completing tasks and the company overall.
- Demonstrate understanding of business and how actions contribute to company performance.
- Demonstrate excellent customer service skills.
- Knowledge of medical terminology, healthcare coding systems, and clinic functions.
- Maintain a complete understanding of payment posting protocols and required software systems.
- Develop and maintain a working knowledge of payer rules and guidelines.
- Track trends, inconsistencies, or discrepancies and resolve and/or escalate to a supervisor as appropriate.
- Strong analytical and problem-solving skills.
- Excellent verbal and written communication skills.
- Proven ability to manage multiple projects at a time while paying strict attention to detail.
- Ability to successfully meet departmental deadlines.
- Ability to follow policies and procedures for compliance, medical billing, and coding.
- Ability to type and enter data with proficiency and accuracy.
- Customer-oriented with ability to remain calm in difficult situations.
- Delivers exceptional patient service throughout all interactions.
- Strong analytical and problem-solving skills.
- Skill in using computer programs and applications including Microsoft Office.
- Ability to work independently and manage deadlines.
- Complies with HIPAA regulations for patient confidentiality.
- Complies with all health and safety policies of the organization.
- High School Diploma or equivalent required.
- Minimum 1 year billing or follow-up experience within a physician's office or medical environment.
- Experience in Urology physician practice environment preferred.
Benefits include no nights, weekends, or holidays, 3 weeks PTO, medical/dental/vision insurance, short-term and long-term disability insurance, life and accident insurance, 401k, and a $2000 referral bonus potential.
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