Medical Claims Resolution Specialist

3 weeks ago


Cincinnati, Ohio, United States Tri State Urologic Services Full time
Job Overview
The Urology Group is seeking a highly skilled Claims Resolution Specialist I to join our team in Norwood, OH. As a key member of our Business Office department, you will be responsible for following up and resolving claims submitted to third-party insurance payers.

About the Role
This full-time position involves working closely with the Business Office Supervisor to escalate claim and denial issues, resolve denials efficiently, and meet or exceed daily/weekly/monthly productivity targets. You will develop and maintain a working knowledge of payer contractual requirements, including initial filing periods, follow-up protocols, and medical policies.

Responsibilities
- Conducts appropriate follow-up of no response third-party receivables in accordance with payer guidelines
- Reviews and resolves claim denials, conducts follow-up, appeals processing, and claim statusing using an appeals template management when appropriate
- Develops and maintains a working knowledge of payer contractual requirements, particularly initial filing periods, appropriate follow-up, and appeal protocols, and medical policies
- Addresses/resolves issues relating to patient accounts while noting account actions for complete audit trail of follow-up activity
- Drafts appeal letters as necessary
- Communicates with Coders, Claim Readiness Specialist, and Business Office staff when necessary to resolve errors and clarify issues
- Stays accountable to quality and productivity standards, and monitoring compliance with policies and procedures
- Identifies process opportunity trends and recommends ways to improve efficiencies
- Ensures adherence to third party and governmental regulations relating to coding, billing, documentation, compliance, and reimbursement
- Participates in special projects, personal development training, and cross-training as instructed
- Informs Supervisor of trends, inconsistencies, discrepancies for immediate resolution
- Works in conjunction with peers and functional areas of the Business Office department for the betterment of completing tasks and the company overall

Requirements
- 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

Compensation and Benefits
This role offers a competitive salary of $55,000 - $65,000 per year, depending on experience, along with a comprehensive benefits package, including health insurance, retirement savings plan, and paid time off.

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