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Claims Resolution Specialist

2 months ago

Richmond, Texas, United States Medix Full time
Medix is seeking a Claims Resolution Specialist to join a prominent healthcare organization. This position offers a valuable opportunity for professional growth and development within the industry.

Key Responsibilities:
  • Assess denial reasons to ensure they are accurate and properly documented.
  • Facilitate clinical consultations or refer accounts as needed.
  • Prepare appeals based on the rationale for disputes and specific contract terms related to the payer.
  • Adhere to specific payer protocols for the submission of appeals.
  • Advance unresolved appeal efforts to higher levels for resolution.
  • Analyze denial reasons on Explanation of Benefits (EOBs) to identify patterns.
  • Input denied claims into the tracking database.
  • Engage in payer projects as assigned.
  • Recognize trends in denials and variances.
Qualifications:
  • Achieve a Quality Assurance score of 9.5, focusing on both timeliness and accuracy.
  • Comprehend industry trends.
  • Possess knowledge of commercial payers and the appeal follow-up process.
  • Meet performance metrics of processing 30 claims daily, including reviewing documentation to assess claim status.
Work Schedule: Monday to Friday, 8:00 AM to 4:30 PM

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