Claims Resolution Specialist

Responsibilities Review errored and rejected claims in SSI Ensure patient demographics, insurance, coding, modifiers, units, and authorization requirements are complete before submission Submit claims electronically or via clearinghouse in a timely manner Monitor and resolve claims in error, hold, wait, and rejected statuses Maintain payer enrollment Validate claims against CMS billing guidelines, payer-specific requirements, and organizational policies Identify and elevate discrepancies to Billing QA, Coding, Patient Access, or the Manager Maintain assigned SSI work queues and work accounts daily Meet productivity and turnaround targets and prevent backlog accumulation Release claims within the established SLA, typically under 24 hours after readiness Identify trends in claim holds or delays and communicate recurring issues to leadership or the Revenue Cycle Analyst Collaborate with cross-functional teams to resolve claim submission barriers Maintain high accuracy and support clean claim rate goals Follow departmental workflows and documentation standards Maintain regular and predictable attendance Perform other essential duties as assigned Requirements High School Diploma or equivalent 2+ years of healthcare billing or revenue cycle experience Residency in Missouri or Kansas is required Patient Access / Registration experience preferred Experience working in an EHR system (MEDITECH preferred) Experience working in clearinghouse (SSI Preferred) Basic understanding of CPT, HCPCS, and ICD-10 coding Basic understanding of insurance billing processes Basic understanding of claim submission workflows Attention to detail and accuracy Time management and ability to meet deadlines Strong organizational skills Effective communication and teamwork Ability to follow standardized workflows Ability to sit and stand intermittently for 8 to 10 hours a day Ability to use standard office equipment, including the telephone and computer keyboard Ability to work under pressure while meeting near 100% accuracy and inflexible deadlines Manual/bi-manual dexterity, near vision, speech, and hearing Ability to lift and/or carry up to 40 lbs. Ability to occasionally walk on uneven surfaces Core Competencies Demonstrates expertise in healthcare billing processes, including claim submission workflows and coding standards such as CPT, HCPCS, and ICD-10. Proven ability to maintain accuracy and meet productivity targets while collaborating with cross-functional teams to resolve claim issues. Highest-signal resume keywords Healthcare Billing Experience Claim Submission Workflows CPT, HCPCS, ICD-10 Coding EHR System Experience Attention to Detail Hard Skills Claim Review Payer Enrollment Claims Validation Insurance Billing Processes Claims Monitoring Productivity Targets Documentation Standards Error Resolution Standardized Workflows Manual Dexterity Soft Skills Effective Communication Time Management Organizational Skills Teamwork Ability to Work Under Pressure Industry Keywords Revenue Cycle Patient Access Claims Processing CMS Billing Guidelines Healthcare Compliance Tools & Technologies EHR System MEDITECH Clearinghouse SSI #J-18808-Ljbffr