Claims Escalation Specialist

Fast Pace Health•UNAVAILABLE, Tennessee

About The Position

The Claims Escalation Specialist is responsible for daily claims escalation and denials management for Fast Pace Health. The role manages outstanding accounts by following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims when appropriate, and following up on denials to ensure claims are processed or reprocessed and paid. The specialist provides effective customer service to internal and external customers through in-depth knowledge and clear communication. The position collaborates with claims escalation leadership, patients, vendors, and internal departments to resolve denials, account conflicts, and outstanding claims. It also supports accurate, compliant claims management and timely resolution through current practice management systems, established procedures, and process improvements. Administrative duties and mandatory compliance training are included. Fast Pace Health describes itself as a growing company that offers employee support and mentoring, professional growth opportunities, competitive compensation, benefits, and opportunities to participate in community events and outreach programs.

Requirements

High school diploma or equivalent.
1–3 years of experience in claims escalation (accounts receivable denials) in a healthcare setting.
Ability to maintain friendly and cordial relations with coworkers, clients, and employees.
Ability to build and maintain confidence and credibility with coworkers.
Ability to communicate and act in a manner that supports positive working relationships with customers, coworkers, and managers.
Ability to comply with company operating standards and maintain confidentiality.

Responsibilities

Collect and manage outstanding accounts, including following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims when appropriate, and pursuing denials through processing or reprocessing and payment.
Collaborate with the Manager of Claims Escalation & Processing and the Director of Revenue Services to report denial trends and support claim resolution.
Work with patients, vendors, and internal departments to resolve account conflicts and outstanding claims involving unapplied or unidentified invoices.
Ensure accuracy in claims escalation and denials management while adhering to applicable regulations.
Help implement and follow policies, procedures, and systems for timely resolution of claims in the current Practice Management system.
Follow objectives, operating policies and procedures, and strategic action plans for achieving goals.
Collaborate with the Manager of Claims Escalation & Processing to develop processes and procedures that improve claims escalation.
Perform administrative duties such as answering phones, faxing, and filing.
Complete mandatory compliance training and learn applicable company compliance requirements.
Maintain friendly, cordial, and respectful relationships with coworkers, clients, and employees, and contribute to a positive work atmosphere.
Maintain confidence and credibility with coworkers and uphold employee, employer, and business confidentiality.
Comply with company operating standards and Core Values, including teamwork, communication, empowerment, quality care, and friendliness.
Perform the physical, sensory, cognitive, and environmental functions specified for the position.
Perform other duties as assigned by management.