Claims Resolution Specialist

­­­­­­­­­­­­­­­­­­­ Duties:

1. Review and understand Insurance policies and standard Explanation of Benefits.


2. Review and understand medical documentation effectively


3. Review and resolve Back Collections related tasks, such as
   
   
   
   1. Denial appeals
   
   
   2. Payment review and balance billing
   
   
   3. Claims generation
   
   
   
   


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


5. Performs other clerical tasks as needed, such as
   
   
   
   1. Answering patient/Insurance calls
   
   
   2. Faxing and Emails
   
   
   
   


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


7. 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)