Claims Resolution Specialist

Claims Resolution Specialist

Cincinnati, Ohio

Contract-to-hire

Pay: $19 to $23

LHH Recruitment Solutions is partnering with our client to hire a Claims Resolution Specialist for a contract-to-hire opportunity. This role is responsible for managing outstanding medical claims, resolving denials, and ensuring accurate and timely reimbursement.

General Description:

This position focuses on following up on unpaid claims, utilizing aging reports, filing appeals when appropriate, and maintaining strong communication with insurance carriers, patients, and internal stakeholders.

Responsibilities:

• Manage workflow related to outstanding accounts receivable, rejected or pending claims, and daily correspondence
• Interpret EOB denials and take appropriate action to resolve claims
• Submit and follow up on medical records requests and additional documentation required by insurance carriers
• Communicate with insurance carriers via phone, portals, and fax, including writing and submitting appeals with supporting documentation
• Respond to inquiries from patients, providers, and insurance representatives in a timely manner
• Monitor and maintain key performance indicators including days in A/R, collection percentages, and aged receivables
• Utilize aging reports to follow up on claims over 30 days past due
• Serve as a resource for billing and coding questions including CPT-4, HCPCS, ICD-9/10, and related guidelines
• Ensure all work is completed within established timelines and complies with applicable regulations
• Manage task queues and prioritize work according to internal procedures
• Escalate complex or high-priority issues to leadership as needed
• Communicate process changes or updates to leadership
• Perform additional duties as assigned

Qualifications:

Education:

High school diploma or equivalent required

Billing certification or related training preferred

Experience:

2+ years of medical billing, claims follow-up, or insurance claims experience required

Experience with physician or clinical billing strongly preferred

Familiarity with practice management systems such as GE Centricity preferred

Experience with electronic and paper claims processing

Radiology billing experience is a plus

Experience using payer web portals

Knowledge of CPT-4, HCPCS, ICD-9/10, and related billing practices

Skills and Abilities:

Strong knowledge of HIPAA regulations

Excellent written and verbal communication skills

High attention to detail and accuracy

Ability to work independently and manage multiple priorities

Strong organizational skills and ability to handle confidential information

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Equal Opportunity Employer/Veterans/Disabled