Medical Claims Specialist
1 week ago
Momentum Resource Solutions is seeking a skilled Claims Resolution Professional to join our team. This role is responsible for reviewing and resolving claims processed by external vendors, including provider appeals and disputes.
Key Responsibilities- Perform root cause analysis to identify areas for provider education and system configuration.
- Initiate and follow through with resolution of all pended claims, (re)pricing, returned or refund checks, and the development of provider and facility compensation grids.
- Communicate with internal and external sources, including providers, members, attorneys, regulatory agencies, and other carriers on claim-related matters.
- Analyze patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions.
- Validate DRG grouping and (re)pricing outcomes presented by the claims processing vendor.
Requirements
- Bachelor's degree in a related field.
- Minimum 2 years of experience in claims resolution or a related field.
- Excellent analytical and problem-solving skills.
- Strong communication and interpersonal skills.
Salary Range: $65,000 - $85,000 per year, depending on experience.
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