Medical Claims Resolution Specialist (Flexible schedule options)

Key Responsibilities

• Daily monitoring of invalid, rejections, and denials from the clearing house.
• Diagnosing error messages and making necessary corrections to ensure claims are accepted electronically.
• Generating and reviewing Insurance Accounts Receivable reports based on the Revenue Cycle Manager's work plan.
• Researching claim denial reasons and taking appropriate follow-up actions to resolve issues.
• Contacting insurance companies for payment requests, overdue payments, and denied claims.
• Identifying and documenting new payer denial trends and notifying supervisors for escalated follow-up.
• Maintaining strong communication with the Billing management team and escalating unresolved claim denials as needed.
• Maintaining confidentiality of patient, medical staff, financial, and healthcare delivery information.

Skills, Knowledge & Expertise

• Excellent mathematical and computer skills, including proficiency in Microsoft applications and word processing programs.
• A minimum typing speed of 40 words per minute.
• Strong writing and verbal communication skills.
• Effective phone skills, both inbound and outbound.
• A strong attention to detail and the ability to prioritize tasks.
• The ability to work independently and as part of a team in a fast-paced environment.
• Able to establish and maintain effective working relationships with insurance carriers, patients, and employees.
• Respect for the confidentiality of medical information.

Requirements

• 4+ years of billing experience within the healthcare industry.
• 4+ years of A/R experience with a proven track record of collecting on accounts.