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Insurance Claims Resolution Specialist

2 months ago

Brentwood, Tennessee, United States MedCycle Management Full time
Job Description

Insurance Follow-Up Representative Overview: We are seeking qualified individuals to engage in insurance follow-up activities. In this position, you will collaborate with a healthcare facility's central business office to address outstanding insurance balances, analyze payer balances, contracts, and Explanation of Benefits (EOBs) to ensure appropriate resolutions.

Key Responsibilities:

  • Proactively initiates actions that lead to account resolution.
  • Responds promptly and accurately to all incoming communications and inquiries from insurance providers and other relevant parties.
  • Contacts patients as necessary to facilitate account resolution.
  • Develops recommendations and action plans aimed at resolving accounts effectively.
  • Handles all phone inquiries in a professional and courteous manner.
  • Documents all actions taken in the system for each account, ensuring thorough record-keeping.
  • Reviews EOBs to confirm that appropriate measures are taken for account resolution.
  • Follows up and takes necessary actions in accordance with MedCycle guidelines.
  • Performs additional duties as assigned by management.

Qualifications:

  • Proficient in Microsoft Office applications, including Outlook, Word, and Excel.
  • Detail-oriented with the ability to research accounts to achieve suitable resolutions.
  • Familiarity with medical terminology and a foundational understanding of insurance processes.
  • Able to solve practical problems and navigate various concrete variables in situations with limited information.

Preferred Qualifications:

  • High school diploma or equivalent; one to three years of related experience and/or training; or a combination of education and experience.
  • A background in healthcare with experience in patient financial services is preferred.
  • Prior experience in insurance billing and/or follow-up is advantageous.