Account Resolution Specialist - Insurance Claims

Account Resolution Specialist - Insurance Claims

Join a dedicated team focused on managing insurance claims and patient account resolutions in a supportive healthcare environment located in the Central Plains region of the United States. This role involves following up with insurance payers to resolve claims, processing account correspondence, and documenting all actions taken on patient accounts.

Essential Functions

• Understand payer contracts, member co-pay, and eligibility requirements.
• Respond to denials from payers related to diagnosis and procedure codes, contractual issues, and medical necessity to ensure proper payment processing.
• Communicate any changes or issues with payer requirements to management and analyze repetitive denials for corrective action.
• Handle patient inquiries via phone and walk-ins professionally and promptly.
• Resolve credit balances and maintain accurate documentation in the patient accounting system.
• Meet productivity standards while adhering to privacy and security regulations concerning Protected Health Information (PHI).

Minimum Knowledge and Skills

• Strong mathematical and written communication skills.
• Basic computer proficiency.
• Effective communication and customer service abilities.
• Proven skills in collections and problem resolution.

Preferred Knowledge and Skills

• Experience in hospital-based patient accounting is a plus.

Required Behavioral Skills

• Integrity: Demonstrate honesty and a commitment to ethical behavior.
• Compassion: Show empathy and provide excellent customer service.
• Accountability: Take ownership of projects and adapt to changing priorities.
• Respect: Collaborate effectively with diverse populations and maintain a positive service orientation.
• Excellence: Exhibit strong communication, leadership, and strategic thinking skills, with the ability to lead process improvements.

Education and Experience

• High school diploma or GED required.
• Recent experience with third-party payer follow-up in a medical setting is essential.
• Hospital-based patient accounting experience preferred.