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.

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)