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Claims Resolution Specialist

2 months ago


Jacksonville, United States Medix Full time
Job DescriptionJob DescriptionJob Duties:
  • Follows-up on all claims that have been billed out in a timely and effective manner.

  • Work all claims to a zero balance resolution through a compilation of options such as interacting
    with the payer directly, using the payer portal, formally appealing, and/or consideration for appropriate adjustment.

  • Verifies all charges on claims are accurate with correct charge amounts including billing correct
    units.

  • Verifies all patient and insurance information on claims to ensure it is accurate.

  • Understands and stays up to date with contractual rates and billing practices

  • Applies critical thinking skills to resolve a claim utilizing appropriate methods by which to interact
    with the payer through specific process and/or technological tools.

  • Considers the value of seeking medical necessity review , coding review, or charge review depending
    on claim denial issue and collaborates with other departments following established processes.

  • Reports to leadership any trends that are being seen with claim denials or billing errors.

  • Helps identify follow-up issues to find root cause of denial.

  • Comprehends and can trouble shoot claim issues as the specialist work queue is built by rules
    of exception.



3-5 Must Have Skills/Qualifications:
  • Physician billing experience
  • EPIC EMR experience
  • Commercial & Government experience
  • Appeals & Claims Follow up experience
  • payor guidelines


Nice to Have Skills:
  • Surgical billing
  • Cancer facility background

Schedule: Full time Monday through Friday (Flexible start time 6:00am-8:30am after training)

Equipment: Provided

Can only be remote out of the following states:

  • AL
  • FL
  • GA
  • ID
  • IN
  • KY
  • LA
  • MI
  • NC
  • OH
  • OK
  • OR
  • SC
  • SD
  • TN
  • TX
  • VA
  • WV
  • WY

Metrics: 20-25 accounts per day

Training: Monday-Friday mirroring others, then EPIC training



Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r
\r
Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?