The Claims Resolution Specialist 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 and will report to the RCM Manager. In this role you will resolve denials, takebacks, and credits. Work directly with the insurance company, the patient, and healthcare providers to get claims processed and paid, review and appeal denied and unpaid claims.
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Submit insurance claims with accuracy, using CPT, ICD-10, and HCPCS codes. Follow up on denials, delays, and unpaid claimsβno loose ends here! Communicate with insurance companies and patients with kindness and clarity. Post payments, adjustments, and write-offs to patient accounts. Verify insurance eligibility and benefits ahead of time. Work closely with providers. Keep patient info secure and stay HIPAA-compliant. Stay on top of billing rules, payer guidelines, and industry changes.
You will respond to inquiries via email, phone, live chat, asynchronous messaging, etc. and provide support for appointment scheduling, account access, benefits, programs, incentives, find care, health screening, company sweepstakes, and more. You will take ownership of resolving customer service and healthcare navigation issues while maintaining customer information confidential and in compliance with HIPAA regulations; work occasional overtime.