Medical Claims Billing Specialist

Under the direction of the Director or Manager of Revenue Cycle Management, the Medical Claims Billing Specialist is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The AR Manager will take steps necessary to resolve all claim issues or questions that escalate to the RCM team. Resolution of SalesForce cases and management of issues and the team resolving the cases is a key element in this role. Primary Job Duties: Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues, denial management, investigating denial sources, resolving and appealing denials which may include contacting payer representatives. Makes independent decisions regarding claim adjustments, resubmission, appeals, and claim resolution techniques. Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate. At times, support large care center go-lives which may include overnight travel. Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements. Performs Denial analysis utilizing the Trizetto platform. Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality.