Claims Resolution Specialist

Integra Partners•Troy, MI

1d•$19•Remote

About The Position

Our Claims Resolution Specialist role is responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy while maintaining appropriate documentation and account records, as well as timely issue resolution. In this role, you will ensure work is in compliance with all legal, regulatory, and internal Integra policies and procedures, including HIPAA compliance. If you have previous medical billing or claims experience, this role may be of interest as a next step in your career.

Requirements

Familiarity with the 1500 claim forms, and DMEPOS services
Knowledge of ICD-10, HCPCS, and medical terminology
Understanding of CMS guidelines, and Medical Policy adopted by the plan
Correctly read and assess medical documents
Must type 45+ words per minute
Computer experience, and the ability to learn new programs and software, Microsoft Word and Microsoft Excel background is a necessity
Conduct yourself in a courteous, helpful, and professional manner at all times
Passion for your work and the mission of the company
Motivated and able to work independently within a fast-paced, team environment
Must be organized and thorough
Sound judgement and critical thinking
Ability to work overtime as required
Must follow policies regarding attendance and punctuality
Meet all daily productivity and weekly quality goals

Responsibilities

Accountable for daily productivity goals at or above the current production metric
Maintain a climate of teamwork and collaborative problem solving
Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectives
Stay informed on product information, changes in Medicare/State/Contract funding procedures, and updates in policies and procedures
Contribute beyond fundamental responsibilities to support company growth and department development
Adds value and positive contributions towards the company and department culture
Understand and perform duties in compliance with State and Federal regulations and the policies and procedures of Integra
Achieve and maintain an individual effectiveness rate of 70% +
Contributes to the department maintaining AR aging over 120 days at 10% or less of total inventory
Strong Microsoft Office skills (Excel in particular) and ability to learn new programs and software
Must type 45+ words per minute
Familiar with ICD-10, HCPCS, and medical terminology
Ability to follow verbal and written instructions
Ability to maintain consistent, regular attendance and punctuality
Performs miscellaneous duties as assigned