Claims Resolution Specialist
About The Position
The Claims Resolution Specialist is a pivotal role in ensuring the efficient and accurate processing of healthcare claims. Primary responsibilities will be to analyze and resolve complex claims issues, ensuring timely reimbursement for healthcare services provided. This role demands a deep understanding of healthcare billing and insurance procedures, exceptional attention to detail, and excellent communication skills. In this role, you will contribute by ensuring claims are processed accurately and efficiently. Your dedication to resolving claims issues will have a direct impact on the overall success of Prominence Health.
Requirements
- High School Diploma. Associates degree preferred.
- Thorough knowledge of CPT, ICD-10 and CDT coding and medical terminology.
- 3+ years’ experience in health care claims processing, preferably in a Medicare environment, including customer service experience.
- Ability to plan, organize, maintain priorities and schedules, as well as assure that deadlines are met.
- Certified coder preferred CCA or CCS designation or must be able to obtain certification within one year of employment.
- Excellent verbal and written communication skills.
- Ability to interpret health plan benefits and provider contracts.
- Must be able to deal with difficult customers in a professional manner.
- Ability to interpret and apply established policies and procedures.
- Excellent computer skills which must include working knowledge of Microsoft Office Suite.
- Must be a team player and have the ability to work independently with little supervision.
Nice To Haves
- Certified coder preferred CCA or CCS designation or must be able to obtain certification within one year of employment.
- Associates degree preferred.
Responsibilities
- Analyze and resolve complex claims issues
- Ensure timely reimbursement for healthcare services provided
- Ensure claims are processed accurately and efficiently
Benefits
- Loan Forgiveness Program
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
1,001-5,000 employees
