Claims Resolution Specialist

Duties: * Review and understand Insurance policies and standard Explanation of Benefits. * Review and understand medical documentation effectively * Review and resolve Back Collections related tasks, such as * Denial appeals * Payment review and balance billing * Claims generation * Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient's benefit. * Performs other clerical tasks as needed, such as * Answering patient/Insurance calls * Faxing and Emails * Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor * Other responsibilities and projects as assigned. Requirements: * High School Diploma or equivalent * Knowledge of Explanation of Benefits from insurance companies * General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid * Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits. * Enough knowledge of policies and procedures to accurately answer questions from internal and external customers. * Utilizes initiative while maintaining set levels of productivity with consistent accuracy. Experience: * 3-5 Years in DME or medical billing experience preferred. * Minimum of 1 year of insurance verification or authorizations required. Skills: * Superior organizational skills. * Proficient in Microsoft Office, including Outlook, Word, and Excel. * Attention to detail and accuracy. * Effective/professional communication skills (written and oral)

Created: 2025-02-14