Claims Resolution Specialist

VieMed Careers • Lafayette, LA

5d

About The Position

This role involves reviewing and understanding insurance policies and Explanation of Benefits, as well as medical documentation. The specialist will be responsible for resolving back collections tasks, including denial appeals, payment reviews, and balance billing. They will also handle claims generation and maintain communication with insurance carriers, patients, and internal teams. Additional clerical duties such as answering calls, faxing, and emailing are also part of the role. The specialist is expected to communicate appropriately with management and report any concerns to the Revenue Cycle Manager and Supervisor. Other responsibilities and projects may be 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.

Nice To Haves

• 3-5 Years in DME or medical billing experience preferred.
• Minimum of 1 year of insurance verification or authorizations required.
• 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.
• 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.

What This Job Offers

• Career Level: Mid Level
• Education Level: High school or GED