Claims Resolution Specialist

TELCOR•Lincoln, NE

1d•Remote

About The Position

The Claims Resolution Specialist performs revenue cycle tasks for TELCOR Revenue Cycle Service customers, including client billing, insurance billing, patient billing, and accounts receivable. The role requires expertise in revenue cycle management workflows, insurance policies and requirements—including payer-specific requirements—and industry knowledge. This is a full-time, non-exempt remote position open to candidates located in Nebraska, Texas, Kansas, Arkansas, or Arizona. The specialist works claim rejections and denials, follows up on claims and unpaid balances, and takes appropriate next steps to facilitate payment, balance transfers, or adjustments. The role also involves communicating with customers and internal leadership, following documented procedures, contributing to team discussions and process development, and serving as a resource to colleagues.

Requirements

Uphold confidentiality and comply with federal, state, and company policies, procedures, and regulations.
Communicate effectively and professionally in writing and verbally, with tact, diplomacy, and respect for others.
Work independently and collaboratively to achieve individual and team goals.
Apply critical thinking and appropriate discernment before taking action or initiating communication.
Use creative thinking to develop, design, and create solutions.
Have strong computer skills and use technology for daily tasks, including Excel, electronic documentation storage and retrieval, keyboarding, mouse navigation, and email/Outlook.
Be self-motivated, analytical, a quick learner, organized, detail-oriented, able to multitask, resilient, and self-disciplined in time management.
Understand the structure, key issues, language, and general billing or revenue cycle environment, and be able to discuss current and emerging issues, including TELCOR products and services relevant to those needs.
Have a thorough understanding of Windows operating system environments and Office tools such as Word and Excel.

Nice To Haves

One or more years of healthcare billing or revenue cycle experience; laboratory billing is a plus. This experience is preferred but not required.
Medical coding education is preferred but not required.

Responsibilities

Analyze and investigate claim rejections, payer rejections, and denials, identifying common issues and trends to improve quality, efficiency, and customer outcomes.
Interpret information and payer or customer requirements, determine appropriate next steps, and act on rejections and denials to facilitate payment, balance transfers, or adjustments.
Follow up on claims with no payer response after submission or resubmission.
Follow Standard Operating Procedures and Best Practices documented or communicated by supervisors and other leaders.
Determine when to bill patients and when to return work to customers for review, feedback, or next steps; take action to keep claims moving through the revenue cycle.
Escalate questions, errors, or setup changes to the TRCS Revenue Cycle Supervisor to support accurate, timely, quality work and claim progression.
Follow up on unpaid balances to obtain payment and prepare, compile, and submit reconsiderations or appeal letters with supporting documentation as necessary.
Demonstrate knowledge of CPT, HCPCS modifiers, ICD-10 codes, and explanation of benefits (EOB) interpretation.
Demonstrate knowledge of payer requirements, clearinghouse portal navigation, and interpretation of information.
Meet regularly with the TRCS team to discuss and identify issues, review team performance, and participate in training and process development.
Take ownership of assigned work, accept new requests, explore opportunities to add value, and recommend improvements.
Understand other team functions, including Client Service Managers, System Administration, Claims Resolution Specialist II, and Remittance Specialists, and how they connect to the revenue cycle.
Meet performance expectations and complete assigned or delegated work within established timelines.
Use analytical thinking and strategy to work efficiently and effectively with the RCM application and other tools; demonstrate fluent knowledge of the RCM application and advanced payer and process knowledge.
Share skills and knowledge and serve as a resource to others when needed.
Perform other duties as assigned.