Claims Resolution Specialist

Medlytix•Roswell, GA

3d•Remote

About The Position

The Claims Resolution Specialist plays a key role in resolving open receivables for our clients. You will process medical (physician and hospital) bills that involve motor vehicle accidents, workers' comp, and third-party claims. The Claims Resolution Specialist will work toward increased reimbursement and account resolution.

Requirements

Experience in healthcare revenue cycle, particularly physician billing, claims resolution, and customer service.
Understanding and concern for patient privacy and HIPAA compliance
Ability to interpret payer EOBs and understanding of coordination-of-benefits concepts.
Excellent customer service, verbal and written communication skills.
Ability to review and interpret account information to successfully resolve account issues.
Attention to detail in identifying, comparing & transferring data (particularly numbers)
Ability to effectively navigate multiple systems to download & transfer files.
Ability to research & follow written guidelines to determine next steps when conflicting information is presented.
Ability to identify trends/issues and communicate these to supervisors.
Basic-to-Intermediate Microsoft Excel Skills
Excellent Data Entry Skills
Bachelor's degree preferred, High School diploma or GED required
2+ Years of Healthcare Revenue Cycle Experience
Inbound Call Center Experience

Nice To Haves

Health Information Management credential (RHIA, RHIT, CAHIMS, CPHIMS) preferred
Preferred bilingual - fluent in speaking Spanish
Preferred prior experience as team-lead, supervisor, or manager

Responsibilities

Works independently to identify issues with claim submissions; identifies corrective steps; follows issue through to resolution.
Provide exceptional customer service for inbound calls.
Interface with insurance agents, patients, and others to the disposition of each account.
Identify obstacles to claim submission and payment, including updating insurances, adjuster contact information, submitting bills, and providing requested documentation.
Identify patterns with payers that result in non-payment or delayed payment. Ability to summarize and escalate in the correct manner.
Update accounts in our proprietary technology platform to increase probability of collection and resolution of accounts.
Rely on experience and judgment as well as instructions and pre-established guidelines to plan and accomplish goals and perform a wide variety of tasks.