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Central Claims Resolution Specialist

2 months ago

Birmingham, Alabama, United States Guidehouse Full time
Job Family:

Patient Account Specialist

Travel Required:

None

Clearance Required:

None

Key Responsibilities:

The Central Claims Resolution Specialist is responsible for conducting comprehensive account evaluations to identify the necessary steps to address outstanding account balances.

This role involves:

  • Reviewing 227 Electronic Files
  • Analyzing 835 Electronic Files
  • Assessing UB04 and 1500 Claim Files
  • Examining Medical Records
  • Making outbound communications to Insurance Providers to resolve claim disputes and account discrepancies.
  • Executing Non-Clinical Appeals
  • Supporting Supervisors/Managers with various projects as required.

Additionally, the Specialist will escalate payer issues or trends to a supervisor, providing the necessary information to facilitate effective resolution.

Regular communication with Supervisors/Managers regarding concerns or potential improvements is essential.

Responsibilities also include:

  • Resubmitting corrected claims along with supporting documentation to enhance the patient experience.
  • Collaborating with other departments to ensure appropriate management of patient accounts.
  • Timely communication of issues to management and performing other duties as assigned by direct supervisors.

The role requires the ability to handle a variety of tasks that may frequently change without a loss of efficiency or composure.

Qualifications:

  • High School Diploma
  • 6 months to 2 years of experience in healthcare claims
  • Experience in revenue cycle management or denials
  • Proficiency in Microsoft Word and Excel
Preferred Skills:

  • Basic computer skills
  • Strong written and verbal communication abilities
  • Capability to facilitate discussions and understand customer issues
  • Independence and flexibility in performing essential job functions
  • Ability to interpret managed healthcare contracts
  • Excellent listening and customer service skills
  • Proactive in initiating and completing projects with minimal supervision
What We Offer:

Guidehouse provides a comprehensive rewards package that includes competitive compensation and a flexible benefits plan, reflecting our commitment to fostering a diverse and supportive workplace.

Benefits include:

  • Medical, Rx, Dental & Vision Insurance
  • Personal and Family Sick Time & Company Paid Holidays
  • Potential eligibility for a discretionary variable incentive bonus
  • Parental Leave
  • 401(k) Retirement Plan
  • Basic Life & Supplemental Life Insurance
  • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
  • Short-Term & Long-Term Disability
  • Tuition Reimbursement and Learning Opportunities
  • Skills Development & Certifications
  • Employee Referral Program
  • Corporate Sponsored Events & Community Outreach
  • Emergency Back-Up Childcare Program
About Guidehouse:

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with applicable law or ordinance.