Claim Resolution Specialist I Position Available In Charleston, South Carolina

Claim Resolution Specialist I Solaris Health Holdings LLC Charleston, SC Job Details Full-time Estimated:

$35.9K – $45.5K a year 1 day ago Qualifications Accounts receivable Managed care ICD coding Basic math Solaris 3 years High school diploma or

GED ICD-10

Analysis skills Medical billing CPT coding Organizational skills Computer skills Entry level Account reconciliation

Full Job Description Description:

GENERAL SUMMARY

The Claim Resolution Specialist is responsible for all steps in resolving patient account balances with insurance payers. This process includes working online with payer websites for inquiries and telephone follow up with the payers to ensure proper reimbursement is received for provider services billed. The specialist will review medical records for appropriate documentation inclusive of correct CPT and payable ICD-10 codes before sending to payer, file necessary appeals or other miscellaneous steps to ensure payment.

Requirements:

ESSENTIAL JOB FUNCTION/COMPETENCIES

Responsibilities include but are not limited to: Provides support services both on the telephone and in office as applicable for patients and authorized representatives regarding patient accounts. Follows up on all outstanding insurance claims at 60 days from the date of billing following established guidelines. Provides information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to providers, client staff and co-workers. Follows up on all returned claims, correspondence, denials, account reconciliations and rebills to achieve maximum reimbursement in a timely manner with emphasis on timely resolution. Recommends accounts for adjustments following department guidelines. Monitors reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contact rates. Answers inquiries from client staff regarding billing issues. Uses payer web sites and eligibility portals to check claim status and to efficiently conduct accounts receivable follow up to maximize revenue. Adhere to all policies related to HIPAA and Medicare compliance. Performs other position related duties as assigned. Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients’ protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS N/A KNOWLEDGE

| SKILLS |

ABILITIES

Skills in computer programs, spreadsheets, payer applications and websites. Requires strong basic mathematical skills. Proficient with facets of the PM (Practice Management) system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry. Requires and extensive working knowledge of managed care networks and insurance carriers. Requires and extensive knowledge of accounts receivable functions including CPT and ICD-10 coding. Excellent organizational skills and attention to detail. Strong analytical and problem-solving skills. Ability to understand and interpret policies and regulations. Ability to examine documents for accuracy and completeness. Ability to prioritize and multi task. Ability to communicate effectively and in a professional manner with others. Complies with HIPAA regulations for patient confidentiality.

EDUCATION REQUIREMENTS

High School Diploma or equivalent required.

EXPERIENCE REQUIREMENTS

Requires minimum of 3 years’ accounts receivable experience and prior experience working in a medical billing office.

REQUIRED TRAVEL N/A PHYSICAL DEMANDS

Carrying Weight Frequency 1-25 lbs. Frequent from 34% to 66% 26-50 lbs. Occasionally from 2% to 33% Pushing/Pulling Frequency 1-25 lbs. Seldom, up to 2% 100 + lbs. Seldom, up to 2% Lifting – Height, Weight Frequency Floor to Chest, 1 -25 lbs.

Occasional:

from 2% to 33% Floor to Chest, 26-50 lbs.

Seldom:

up to 2% Floor to Waist, 1-25 lbs.

Occasional:

from 2% to 33% Floor to Waist, 26-50 lbs.

Seldom:

up to 2%