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Centralized Claims Resolution Specialist

2 months ago

Birmingham, Alabama, United States Guidehouse Full time

Job Family:
Patient Account Representative

Travel Required:
None

Clearance Required:
None

Key Responsibilities:

The Centralized Claims Resolution Specialist performs comprehensive account evaluations to identify the necessary steps for addressing account balances.


This role encompasses the following tasks: reviewing and processing 227 Electronic Files, 835 Electronic Files, UB04's, and 1500 Claim Files, as well as Medical Records. The specialist will also make outbound calls to insurance providers to address claim denials and outstanding account balances.

Additional responsibilities include conducting Non-Clinical Appeals and assisting Supervisors/Managers with various projects as required. The specialist will escalate payer issues and trends to a supervisor, providing the relevant information to facilitate effective resolution.

Moreover, the role involves resubmitting corrected claims along with supporting documentation to enhance the patient experience. Effective communication with other departments is essential to ensure the proper management of patient accounts. The specialist will promptly inform management of any issues and undertake other duties as assigned by direct supervisors.

This position requires the ability to perform a variety of tasks, often shifting from one type of duty to another without losing efficiency or composure.


Qualifications:


High School Diploma
6 months to 2 years of experience in healthcare claims
Experience in revenue cycle or denials management
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
Creative problem-solving skills
Ability to interpret and apply reimbursement aspects of managed healthcare contracts
Excellent listening skills
Exceptional customer service skills, including effective problem-solving and analytical abilities
Initiative to start and complete 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
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, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program.

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.