Insurance Claims Processing

Recovery & Wellness Centers of Midwest Ohio•Greenville, OH

About The Position

Values: Employees of Darke County Recovery Services, DBA Recovery and Wellness Centers of Midwest Ohio are expected to value highest ethical standards, quality clinical care, and good customer service. We also value quality communication skills in a collaborative, multidisciplinary and often multi-agency service environment

Requirements

High school diploma/GED.
1-2 years prior Medical Billing Experience
1-2 years’ experience performing general office duties
1-2 years’ experience using Microsoft Office Operation Systems and Applications

Responsibilities

Claims Review & Resolution
Examine denied or underpaid insurance claims to determine reasons for denial.
Research payer guidelines, coding requirements, and policy rules to determine appropriate next steps.
Correct claim errors, gather additional documentation, and resubmit or appeal claims as necessary.
Maintain accurate records of denial reasons, corrective actions, and resolution outcomes.
Appeals & Follow-Up
Prepare and submit timely appeals supported with medical records, coding justification, or policy clarification.
Communicate with insurance companies to dispute incorrect denials or request reconsideration.
Track open appeals and follow up until payment, partial approval, or final determination.
Collaboration & Communication
Coordinate with physicians, coders, billing staff, and administrative teams to resolve documentation issues.
Educate staff on common denial trends and recommend process improvements.
Communicate clearly with patients when additional information is needed.
Data & Reporting
Document denial categories and recovery metrics for management review.
Identify recurring denial patterns and work with leadership to reduce preventable denials.
Utilize billing software, electronic health records (EHR), and payer portals to complete daily tasks.