Claims Resolution Specialist

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.
• 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)