Resolution Specialist

Aspirion • Alameda, CA

just now • $18 - $23 • Remote

About The Position

Aspirion is seeking an engaged and driven Follow-Up Representative for their Zero Balance team. A successful Resolution Specialist will support the success of a high-volume, fast-paced revenue cycle process by helping to follow up on accounts in a timely manner, navigate independently through multiple applications, payer portals and other websites, express critical thinking in independent work, and demonstrate high capabilities of computer literacy when independently troubleshooting issues or working with tech support. The role involves completing appropriate actions for timely claims follow-up and effective appeals submission, including research, rebilling, adjustments, transfers, and escalating payer issues. It also requires corresponding professionally with third-party commercial insurance payers, using provided reference materials and payer websites to troubleshoot claims issues, and utilizing payer portals and internal systems for account follow-up and resolution. The specialist will navigate payer guidelines and reimbursement workflows, review and analyze payer, IPA, and medical group responsibility for underpayments and denials, and communicate and collaborate with team members. Assigned work queues or tasks must be completed within leadership-assigned timeframes.

Requirements

• Working knowledge of EOBs, EFTs and ERAs, patient liabilities, and insurance or third-party correspondences
• Strong facility-based revenue cycle background with experience navigating underpayments, denials, payer follow-up, and reimbursement workflows required
• Facility or hospital billing experience required; professional billing only experience is not ideal
• Understanding of medical terminology, payer responsibility determination, and claims resolution processes required
• Demonstrated ability to adapt within a high volume, fast paced revenue cycle team
• Demonstrated ability to interpret EOBs, denials, and appeals
• Demonstrated ability to efficiently call insurance payers
• Ability to utilize websites and payer portals when applicable
• Express critical thinking in independent work
• Demonstrate high capabilities of computer literacy
• Adaptability and ability to work with a diverse team and client base
• Ability to work within deadlines while remaining flexible and organized
• Excellent communication, both written, verbal and demonstrated listening skills
• Ability to learn within a 100% remote environment
• Secure working location with no interruptions during working hours
• High proficiency with standard office equipment and software such as Microsoft Office products, knowledge of Health Information Systems, 10-key, multi-line telephone
• Ability to identify financially responsible parties across payer, IPA, and medical group structures
• High school diploma or equivalent

Nice To Haves

• Bachelor's degree preferred
• Healthcare billing knowledge preferred
• Previous experience supporting facility-based payment variance, denial resolution, or appeals processes preferred
• Familiarity with California healthcare reimbursement guidelines and managed care structures preferred
• Previous experience working within Epic and payer portal systems preferred
• Experience reviewing contracts, reimbursement matrices, and appeal submissions preferred
• Knowledge of IPAs, medical groups, capitated agreements, and DOFR (Division of Financial Responsibility) preferred
• Familiarity with California-specific payers and guidelines including IEHP, CCS, Aetna, Regal Medical Group, Molina, Kaiser, and Blue Cross preferred
• California payer and medical group/IPA experience preferred
• Facility or hospital healthcare billing knowledge strongly preferred
• Previous work from home experience preferred

Responsibilities

• Complete appropriate actions needed for timely claims follow up and effective appeals submission including research, rebilling, adjustments, transfers to next responsible parties, and escalating payer issues to Leadership
• Correspond professionally with third party commercial insurance payers to obtain information required for effective claims resolution
• Use provided references materials to troubleshoot claims issues and increase understanding of claims resolution techniques. Reference payer websites as needed
• Utilize payer portals and internal systems to support account follow-up and resolution activities.
• Navigate payer guidelines and reimbursement workflows to support accurate claims resolution
• Review and analyze payer, IPA, and medical group responsibility for underpayments and denials based on DOFR and capitated agreement structures
• Communicate and collaborate well with other team members
• Complete assigned work queues or tasks within timeframes assigned by Leadership

Benefits

• flexible scheduling is available between 6:30 AM – 6:30 PM EST based on business needs, project demands, training completion, and demonstrated ability to work independently.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED