Claims Resolution Specialist

Claims Resolution Specialist

Advantia is seeking a Claims Resolution Specialist to join our team! As a Claims Resolution Specialist, you will be essential in ensuring the accuracy and timeliness of billing and reimbursement for medical services. This important role demands a solid understanding of medical terminology, coding, and billing procedures. This role will report to the RCM Manager.

Job Responsibilities:

• Work assigned holds and worklists to effectively resolve denials, takebacks, and credits.
• Work directly with the insurance company, the patient, and the healthcare provider to get claims processed and ultimately paid.
• Review and appeal denied and unpaid claims.
• Call insurance companies/payers regarding any discrepancies in payments.
• Follow insurance guidelines and policies, and CMS guidelines and rules.
• Perform rebill projects and additional daily reports
• Verify patients' insurance coverage and update claims/charts as needed.
• Review patient bills for accuracy and completeness and obtain any missing information.
• Answering patient inquiries regarding billing, insurance and payments as needed
• Acting as a primary billing resource and support to practice staff.

Job Requirements:

• High School/GED Education required
• Previous experience in medical billing or a related field is preferred.
• Proficiency in electronic health records and billing software preferred.
• Athena experience preferred.

Please note: Advantia Health provides unparalleled healthcare to our customers by employing the most highly qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. COVID-19 and Flu vaccination or an approved request for accommodation is required as a condition of employment.

Advantia Health is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage EOE M/F/D/V.