Claims Resolution Specialist

Job TitleDuties:Review and understand Insurance policies and standard Explanation of Benefits.Review and understand medical documentation effectivelyReview and resolve Back Collections related tasks, such as: Denial appealsPayment review and balance billingClaims generationEstablishes 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 callsFaxing and EmailsCommunicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and SupervisorOther responsibilities and projects as assigned.Requirements:High School Diploma or equivalentKnowledge of Explanation of Benefits from insurance companiesGeneral knowledge of government, regulatory billing and compliance regulations/policies for Medicare & MedicaidWorking 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)Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.