Medical Claims Resolution Specialist

4 weeks ago


Lafayette, Louisiana, United States VieMed Full time

Job Summary:

VieMed is seeking a skilled Medical Claims Resolution Specialist to join our team. As a Medical Claims Resolution Specialist, you will be responsible for reviewing and understanding insurance policies and standard Explanation of Benefits. You will also review and understand medical documentation effectively, and resolve Back Collections related tasks, such as denial appeals, payment review and balance billing, and claims generation.

Key Responsibilities:

  • Review and understand insurance policies and standard Explanation of Benefits
  • Review and understand medical documentation effectively
  • Resolve Back Collections related tasks, such as denial appeals, payment review and balance billing, and claims generation
  • Establish and maintain effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient's benefit
  • Perform other clerical tasks as needed, such as answering patient/insurance calls, faxing and emailing
  • Communicate appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor

Requirements:

  • High School Diploma or equivalent
  • Knowledge of Explanation of Benefits from insurance companies
  • General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid
  • Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits
  • Enough knowledge of policies and procedures to accurately answer questions from internal and external customers
  • Utilizes initiative while maintaining set levels of productivity with consistent accuracy

Experience:

  • 3-5 Years in DME or medical billing experience preferred
  • Minimum of 1 year of insurance verification or authorizations required

Skills:

  • Superior organizational skills
  • Proficient in Microsoft Office, including Outlook, Word, and Excel
  • Attention to detail and accuracy
  • Effective/professional communication skills (written and oral)

Equal Opportunity Employer:

VieMed is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and respectful work environment.



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