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.