Claims Resolution Specialist - Part Time

VieMed Healthcare • Lafayette, LA

3d

About The Position

This part-time role involves reviewing insurance policies and medical documentation to resolve back collections tasks, including denial appeals, payment reviews, and claims generation. The specialist will also maintain communication with insurance carriers, patients, and internal teams, and perform various clerical duties such as answering calls and managing faxes and emails. Effective communication with management and reporting of concerns are essential.

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.

Nice To Haves

• Superior organizational skills.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.
• Attention to detail and accuracy.
• Effective/professional communication skills (written and oral).

Responsibilities

• 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, and claims generation.
• Establish and maintain effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient’s benefit.
• Perform other clerical tasks as needed, such as answering patient/Insurance calls, faxing and Emails.
• Communicate appropriately and clearly to Manager/Supervisor, and other superiors. Report all concerns or issues directly to Revenue Cycle Manager and Supervisor.
• Other responsibilities and projects as assigned.

What This Job Offers

• Job Type: Part-time
• Career Level: Entry Level
• Education Level: High school or GED