Medical Claims Resolution Specialist

Asset Protection Unit Inc • Amarillo, TX

136d

About The Position

Asset Protection Unit Inc. seeks a detail-oriented Medical Claims Resolution Specialist to join our team. You will be responsible for resolving all billing issues, claim appeals, respond to disputes from medical providers, and provide internal program concept suggestions. This is a great opportunity for someone who enjoys problem solving, working collaboratively, and contributing to a high performing audit team.

Requirements

• High school diploma or equivalent required
• Certified Professional Coder
• Minimum 2 years of medical billing and coding experience required
• Experience in processing Medicare/Medicaid billing or auditing is required
• Strong interpersonal skills, oral and written communication skills
• Be able to work independently
• Must be able to focus on the task at hand for an entire day
• Be detail oriented, accurate, efficient, and precise in completing the tasks associated with the position

Nice To Haves

• Post high school education or certification is preferred
• Proficiency with technology, especially computers and software applications
• Intermediate knowledge of Microsoft Excel and Word
• Mainframe, 'green screen' experience is preferred
• Two years or more of experience with insurance claims examination or processing is highly preferred

Responsibilities

• Examine medical claims by reviewing EOBs, CPT procedures, fee schedules, and other documentation
• Process appeals and reconsiderations for denial claims
• Accurately review and resolve all medical claim appeals/disputes and respond to medical providers in a timely manner
• Research medical claim documentation
• Communicate with internal team members and external providers regarding medical claims, appeals and overpayments
• Understanding of CPT, ICD-10 coding as well as NCDs, LCDs, CCI Edits
• Investigate claim data to provide feedback, propose concept ideas to identify overpayment opportunities
• Research rejections included in EOBs for resolution and files appropriately
• Identify and research frequent causes of denials so corrective action plans can be implemented
• Collaborate with internal staff to address discrepancies or issues
• Meets established daily, weekly and monthly deadlines
• Strong understanding of physiology, medical terms and anatomy
• Ensure compliance with regulatory standards
• Maintain policies, procedures, and training guides
• Complete other duties, as assigned

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• Long-term disability insurance
• 401k
• Paid time off (PTO)
• Holiday pay

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 101-250 employees