Claims Resolution Specialist-I

Innovaccer Analytics

4d•Remote

About The Position

Innovaccer is hiring a Claims Resolution Specialist I (CRS-I) to process medical claims according to Caduceus standards, client-specific requirements, and industry guidelines. The role supports large-scale, multi-specialty and multi-site healthcare organizations across the United States and requires working knowledge of revenue cycle processes. The specialist performs accounts receivable follow-up on front-end claim scrubs and back-end denials, reviews and clears claim edits, interprets explanations of benefits and denials, and processes appeals across payer categories. The role also involves contacting insurance companies, using billing and insurance portals, communicating issues and trends, and meeting productivity, accuracy, and quality standards. The position requires working independently and staying focused in a remote environment, as well as demonstrating mastery of essential functions in a testing environment. The work environment is a standard business setting with moderate noise, extended sitting and computer use, and occasional lifting and moving of approximately 30 pounds. The role involves handling and grasping objects and controls, close vision, and receiving detailed information through oral and telephone communication.

Requirements

At least 3 years of experience in claims resolution or medical billing.
Working knowledge of CPT, ICD-10, and medical terminology.
Complete understanding of follow-up processes.
Solid background in accounts receivable and revenue cycle policies and procedures.
Experience in a medical billing environment with strong enforcement of protected health information and HIPAA compliance.
Excellent communication skills, including the ability to communicate clearly orally and in writing and effectively with senior leadership and company personnel.
Strong systems experience and acuity with EMR, billing, and collection systems.
Proficiency in Microsoft Office Suite, including Word and Excel.
Ability to plan, manage, and lead projects.
Ability to make decisions and solve problems under pressure.
Ability to prioritize and organize effectively.
Ability to use judgment and initiative and accomplish job duties.
Ability to work independently.
Strong business acumen.
Effective communication skills, including public speaking.
Ability to stay focused and productive in a remote environment.
Ability to lift and move approximately 30 pounds on a non-routine basis, sit for extended periods, and use a computer for long periods.
Ability to handle, seize, hold, grasp, and finger objects, tools, and controls; close vision; and ability to receive detailed information through oral and telephone communication.

Nice To Haves

At least 2 years of documented experience using the Athena billing platform.
Experience with Cerner, NextGen, or EPIC.
Formal certification in medical billing.
Multi-system and multi-specialty experience.
Bachelor’s degree or medical billing certificate.

Responsibilities

Conduct accounts receivable follow-up on front-end scrubs and back-end denials using established best practices.
Scrub charges for submission and launch appeals through the Athena billing platform.
Review and clear claim edits, including registration, insurance, charge, and related issues for high-volume practices.
Read and interpret explanations of benefits and denials from insurance carriers, including copays, deductibles, and coinsurance.
Process appeals end to end across payer categories based on insurance denials.
Distinguish when to pursue an appeal, coding review, credentialing review, or adjustment.
Contact insurance companies and use web portals and websites to obtain appeal, eligibility, remittance, and payment information.
Report and communicate issues and trends.
Meet or exceed an average productivity expectation of at least six denials per hour (approximately 45 per day) while maintaining accuracy and quality standards.
Demonstrate mastery of essential functions with passing grades in a testing environment.
Perform other duties as assigned.