Claims Resolution Specialist

Claims Resolution Specialist

Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.

• Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years.
• Conduct AR follow-up both on front end scrubs and back end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
• Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
• Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
• Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
• Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
• Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
• Candidate must be able to report and communicate issues and trends.
• Meet or exceed daily productivity benchmarks.

Knowledge, Skill, and Experience Requirements:

• 3+ years of experience in claims resolution or medical billing.
• A minimum of 3 years of documented experience on the Athena billing platform is required.
• Working knowledge of CPT, ICD-10, and medical terminology.
• Complete understanding of follow-up processes.
• Solid background in AR and overall revenue cycle policies and procedures.
• Experience working in a physician billing environment.
• Excellent communication skills.
• Proficiency in Microsoft Office Suite, including Word and Excel.