Claims Resolution Specialist

5 days ago

Cincinnati, Ohio, United States Tri State Urologic Services Full time
Job Title: Claims Resolution Specialist

We are seeking a highly skilled Claims Resolution Specialist to join our team at Tri State Urologic Services. 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 template management when appropriate.
  • 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 trail of follow-up activity.
  • Draft appeal letters as necessary.
  • Communicate with Coders, Claim Readiness Specialist, and Business Office staff when necessary to resolve errors and clarify issues.
  • Stay accountable to quality and productivity standards, and monitoring 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.
Requirements:
  • Demonstrate understanding of business and how actions contribute to company performance.
  • Demonstrate excellent customer service skills.
  • Knowledge of medical terminology, healthcare coding systems, and clinics 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.
Education and Experience:
  • 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.

We offer a competitive salary and benefits package, including 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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