Claims Resolution Specialist
: Job Details :

Duties:

Review and understand Insurance policies and standard Explanation of Benefits.

Review and understand medical documentation effectively

Review and resolve Back Collections related tasks, such as

Denial appeals

Payment review and balance billing

Claims generation

Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient's benefit.

Performs other clerical tasks as needed, such as

Answering patient/Insurance calls

Faxing and Emails

Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor

Other responsibilities and projects as assigned.

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/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)