Medical Claims Insurance Specialist - Remote

Kroger • Nashville, TN

223d • Remote

About The Position

The position requires a thorough working knowledge of the revenue cycle management process. The individual will be responsible for the research and resolution of aging account receivables that are either unpaid or incorrectly paid. The role emphasizes the demonstration of the company's core values, which include respect, honesty, integrity, diversity, inclusion, and safety.

Requirements

• High school diploma.
• 1+ year of insurance follow-up including working knowledge of the appeals resolution process.
• Strong written and oral communication skills.
• Analytical and problem-solving capabilities with close attention to detail.
• Excellent organizational and follow-up skills.
• Thorough working knowledge of revenue cycle management including medical terminology, ICD-9, ICD-10, CPT-4 coding, Medicare reimbursement guidelines, billing and collection practices.
• Ability to read and interpret EOB's.
• Highly self-motivated, with ability to work independently and meet deadlines.
• Ability to remain flexible during times of change and adjust promptly and effectively.
• Must be able to learn, understand, and apply new technologies.

Responsibilities

• Analyze, audit and resolve claims outstanding, denied, or incorrectly paid.
• Review and respond to payer correspondence.
• Submit appeals as needed for denied claims.
• Contact insurance companies and navigate payer websites to secure and expedite insurance payments.
• Resolve patient billing inquiries.
• Document in detail all actions taken in accounts receivable system.
• Meet productivity expectations as outlined by supervisor.
• Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims.
• Answer and resolve inbound calls from insurance carriers.
• Participate in process improvement initiatives as needed.
• Keep current with Medicare and other third party administrators regulations and procedures.
• Manage any special projects requested by supervisor or team lead.

What This Job Offers

• Industry: Food and Beverage Retailers
• Education Level: High school or GED