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Claims Resolution Specialist
2 months ago
Position Type: Remote (available to residents of specific states)
Role Summary:
The Claims Resolution Specialist plays a crucial role in addressing insurance claim denials by meticulously reviewing claims and associated clinical documentation, processing payments, managing correspondence, and drafting appeals to rectify payment discrepancies.
Key Responsibilities:
- Examine and contest unpaid and denied claims
- Attach necessary documentation to appeal letters
- Investigate and assess insurance payments and related correspondence for precision
- Document appeals and grievances, monitoring the status of claims
- Maintain current reports and identify trends related to insurance denials
- Contact insurance providers to inquire about claims, refund requests, and payments
- Oversee Accounts Receivable reports for the Billing Department
- Utilize EMR systems to submit and amend claims
- Record patient and insurance payments
- Send paper claims to insurance companies
- Address patient billing inquiries
- Coordinate payment of medical and billing records with patients and/or third-party payers
- Manage collections on outstanding accounts
- Identify and resolve patient billing issues
- Respond to phone inquiries in a timely and professional manner
- Process credit card payments both over the phone and in person
- Safeguard the practice by adhering to professional standards, policies, and regulations
- Enhance the practice's reputation by taking ownership of new and diverse requests; seek opportunities to add value to job outcomes
- Operate standard office equipment (e.g., copier, personal computer, fax, etc.)
- Maintain regular and predictable attendance
- Comply with company policies and procedures
- Perform additional duties as assigned
Qualifications:
Education: High school diploma or GED required
Experience: Minimum of three years of relevant work experience or training
Skills and Competencies:
- Clear and effective communication abilities
- Strong attention to detail
- Ability to prioritize and manage daily tasks efficiently
- Excellent phone etiquette and customer service skills
- Commitment to protecting patient information and maintaining confidentiality
- Familiarity with medical terminology, CPT, ICD-9, and ICD-10 coding
- Experience in analyzing electronic remittance advice and electronic fund transfers
- Ability to interpret zero pays and insurance denials
- Competence in addressing patient inquiries regarding billing statements
- Strong organizational skills with problem identification and resolution capabilities
- Ability to work independently as well as collaboratively within a team
- Proficient written and verbal communication skills
- Interpersonal skills for effective human relations
Work Environment:
Conditions: Medical office setting
Physical Requirements:
- Ability to work as scheduled, typically during standard business hours
- Capability to sit and/or stand for extended periods
- Ability to bend, stoop, and stretch as needed
- Capacity to lift and move items weighing up to 30 pounds
- Requires manual dexterity and coordination to operate office equipment
