Claims Resolution Specialist

Claims Resolution Specialist

Department: RCS Claims Direct

Reports To: Revenue Cycle Supervisor

Location: Remote in the following states: NE TX KS AR AZ

Employment Type: Full-Time Non-Exempt

About TELCOR

Founded in 1995 and headquartered in Lincoln Nebraska with an office in San Francisco California TELCOR is a proven leader in healthcare software delivering Point of Care (POC) middleware Revenue Cycle Management (RCM) software RCM managed billing services and AI-driven solutions to hospitals health systems and independent laboratories nationwide. TELCOR is Great Place to Work Certified and our core values integrity innovation dedication acceptance passion and collaboration guide how we build products and work with one another.

Job Summary

The TRCS Claims Resolution Specialist is responsible for performing revenue cycle tasks for TELCOR Revenue Cycle Service customers. The Claims Resolution Specialist responsibilities include; client billing insurance billing patient billing and accounts addition the Claims Resolution Specialist will demonstrate expertise in RCM workflow insurance policies and requirements including payer-specific policies and requirements and industry knowledge.

Responsibilities

Claims Resolution Specialist

Responsible for working claim rejections payer rejections and payer denials by performing analysis and investigation of individual scenarios while identifying commonalities or trends within current worklists or across future and past worklists in order to continuously improve quality efficiency and customer outcomes for TRCS Success

Responsible for follow up and taking action by interpreting information making determinations applying knowledge and executing appropriate next steps on payer rejections and denials in order to facilitate payment balance transfers or adjustments based on customer-specific and/or payer-specific requirements

Responsible for follow-up on claims with no payer response after submission or resubmission

Adhering and referring to the requirements in accordance with Standard Operating Procedures or Best Practices as documented or as verbalized from supervisors or other leadership

Responsible for determining and knowing when to bill a patient and when to assign work back to the customer for review feedback or completion of next steps and taking appropriate action to keep the claim moving through the revenue cycle

Responsible for escalating questions errors or setup changes to TRCS Revenue Cycle Supervisor in order to keep the claim moving through the revenue cycle and to produce accurate timely and quality work

Responsible for follow up and taking appropriate next steps on claims with no payer response to facilitate payment or balance transfers to other responsible parties

Demonstrate knowledge of CPT HCPCs modifiers ICD-10 codes and EOB interpretation

Demonstrate knowledge of payer requirements clearinghouse portal navigation and appropriate interpretation of information

Meet with the TRCS team on a regular basis to discuss and identify issues review team performance participate in ongoing training and process development

Enhance business line organization and success by accepting ownership for accomplishing new and different requests exploring opportunities to add value to job accomplishments and making recommendations on ways to improve

Demonstrate basic knowledge of other team member functions such as Client Service Managers System Administration Claims Resolution Specialist II and Remittance Specialists in order to execute Claims Resolution Specialist I job functions with an understanding of how the entire revenue cycle is interconnected

Meet performance expectations set forth by supervisors and leadership team

Stay current on work assigned or delegated within timelines and timeframes established as standard expectations or as set forth by supervisors or other leadership

Demonstrate the ability to think analytically and apply strategy to use of and interaction with the RCM application and other tools to be more efficient and effective

Demonstrate fluent knowledge of the RCM application

Demonstrate advanced payer and process knowledge

Accurately and effectively serve as a resource to others for questions and direction when needed by demonstrating the ability to share skills and knowledge with others

Claims Resolution Specialists may be placed in or assigned to areas of focus or specialization

Responsible for follow-up on unpaid balances to obtain payment and write compile and submit reconsiderations or appeal letters with supporting documentation as necessary.

Additional duties may be assigned.

Required Qualifications:

Must be able to uphold confidentiality and comply with federal state and company policy procedures and regulations.

Ability to effectively and professionally communicate both in writing and verbally with tact diplomacy and respect for others.

Must be able to work independently and with team to achieve individual and team goals.

Must be able to apply critical thinking and appropriate discernment in all activities and job functions before taking action or initiating communication.

Must possess creative thinking skills to develop design and create solutions.

Must have strong computer skills and be able to leverage and navigate using technology to complete daily tasks (e.g. Excel electronic documentation storage and retrieval keyboarding and mouse navigation email/outlook).

Self-motivated analytical quick learner organized detail oriented multi-tasker resilient self-disciplined in time management.

Ability to demonstrate understanding of the structure key issues language and the general billing or revenue cycle environment with an ability to discuss and explain current and emerging issues including TELCOR products and services applicable to those needs.

Must have a thorough understanding of Windows operating system environments and Office tools; e.g. Word Excel

Preferred Qualifications:

One or more years of healthcare billing or revenue cycle experience (laboratory billing a plus) or medical coding education preferred but not required.

This is a remote role we are currently only hiring in one of the following states: NE TX KS AR AZ

TELCOR is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or protected veteran status or any other characteristic protected by law.

Required Experience:

IC