Medical Claims Resolution Representative

JOB TITTLE: Medical Claims Resolution Representative

DEPARTMENT: Billing

REPORTS TO: Supervisor

JOB SUMMARY: Responsible for billing cycle from multiple providers in various specialties, mainly investigating, reviewing and appealing unpaid or denied claims. This position also assists in monitoring account balances from both insurances and patients.

JOB DUTIES/RESPONSIBILITIES – The main goal is to investigate, analyze and resolve any denied or pending insurance claim to ensure accurate reimbursement. Some of their primary day-to-day responsibilities include:

• Understands the importance of working collaboratively with both our offices and our clients to ensure an efficient workflow
• Electronic and paper insurance claims processing, follow-up, and reprocessing if needed
• Review, analyze, and resolve all insurance claims, ensuring accuracy and compliance
• Identify, research, and appeal denied claims by communicating with insurance companies and healthcare providers
• Posting electronic or paper EOBs, and working account aging, if necessary
• Verification/correction of patient demographics
• Communicate with insurance representatives, other departments within the billing office, and management team
• Maintain strict confidentiality in accordance with HIPAA regulations
• Handle patient billing inquiries, explain EOBs, and set up payment plans if necessary
• Maintain knowledge of payer requirements and coding standards (ICD-10, CPT)
• Achieve team productivity and performance benchmarks consistently
• Performs other related duties as assigned by management

SUPERVISORY RESPONSIBILITIES: This job position has no supervisory responsibilities.

QUALIFICATIONS/KNOWLEDGE/SKILLS:

• High school diploma or equivalent
• Some college courses - Preferred but not required
• Strong written and interpersonal communication skills
• High level of accuracy and problem-solving ability
• Systems and software proficiency, including Microsoft Office
• Ability to maintain confidentiality and exercise extreme discretion
• Coding classes/certification - Preferred
• Medical billing or coding experience required

Success Criteria

• Achieve team productivity and performance benchmarks consistently
• Maintain a 99% or higher net collections per provider
• Ensure all tasks and projects are completed within the established deadlines
• Maintain a culture of trust and accountability within their team

STANDARD PHYSICAL DEMANDS AND WORKING CONDITIONS: The work is performed in a conventional medical office setting. It requires manual dexterity to operate keyboard and other office equipment; sitting at computer terminal for long periods of time; corrected vision and hearing to normal range; and the occasional overtime to complete tasks for accurate Month End Reports.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be taken as a complete description of all duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Pay: $14.00 - $20.00 per hour

Benefits:

• Paid time off

People with a criminal record are encouraged to apply

Work Location: In person