Physician Claims Resolution Specialist ProScan Imaging, LLC - 3.2 Cincinnati, OH Job Details Full-time 20 hours ago Benefits Health savings account Health insurance Dental insurance 401(k) Flexible spending account Paid time off Vision insurance 401(k) matching Life insurance Qualifications Phone communication Customer service HIPAA High school diploma or GED Organizational skills Business Administration Associate's degree Medical terminology Full Job Description ProScan Imaging is seeking a full-time, Physician Claims Resolution Specialist at our Midtown location.

Position Summary:

The Physician Claims Specialist is responsible for managing and resolving physician-related billing issues to ensure timely and accurate claim reimbursement. This role serves as the primary liaison between the billing department, physicians, coding staff, credentialing, and payer representatives to resolve documentation, coding, enrollment, and claim issues that require physician involvement. The specialist works proactively to reduce denials, improve reimbursement, and maintain compliance with payer and regulatory requirements.

Essential Duties and Responsibilities:

• Review and resolve physician-related billing edits, denials, and claim rejections.
• Obtain missing physician documentation, signatures, or clarifications needed for claim submission.
• Communicate directly with physicians and clinical staff regarding documentation deficiencies affecting reimbursement.
• Research denied or unpaid claims to determine root cause and coordinate resolution.
• Monitor payer-specific requirements related to physician enrollment, credentialing, documentation, and billing guidelines.
• Collaborate with Coding, Credentialing, Revenue Cycle, and Clinical Operations to resolve billing issues efficiently.
• Track and follow up on outstanding physician-related requests to ensure timely resolution.
• Identify trends in denials or documentation issues and recommend process improvements.
• Maintain accurate documentation of follow-up activities within the billing system.
• Assist with appeals by gathering supporting documentation and physician statements when needed.
• Monitor aging accounts requiring physician action and prioritize based on timely filing requirements.
• Educate providers on common documentation issues that impact reimbursement.
• Participate in special projects, audits, and workflow improvement initiatives.
• Maintain compliance with

HIPAA, CMS

regulations, payer guidelines, and company policies.

Knowledge, Skills, and Abilities:

• Strong understanding of medical billing, claims processing, and revenue cycle management.
• Knowledge of CPT, ICD-10-CM, HCPCS, and payer billing guidelines.
• Excellent analytical and problem-solving skills.
• Strong written and verbal communication skills with the ability to interact professionally with physicians and leadership.
• Ability to prioritize multiple assignments and meet deadlines.
• Detail-oriented with strong organizational skills.
• Proficient in Microsoft Office, billing systems, and electronic medical records.
• Ability to work independently while collaborating effectively across departments.

Minimum Qualifications:

• High school diploma or equivalent required.
• Associate's degree in Healthcare Administration, Business, or related field preferred.
• Minimum of 2 years of experience in medical billing, physician billing, denial management, or revenue cycle operations.
• Experience working with physician documentation and payer requirements preferred.

Preferred Qualifications:

• Experience with radiology or diagnostic imaging billing.
• Knowledge of Medicare, Medicaid, and commercial insurance regulations.
• Certification such as CPB, CPC, or CRCR is a plus.

Physical Requirements:

• Prolonged periods of sitting and computer work.
• Ability to communicate effectively by phone, email, and in person.
• Ability to occasionally lift up to 15 pounds.

Work Environment:

This position is primarily performed in an office environment and may be eligible for a hybrid work arrangement based on departmental needs and company policy.

Job Type:

Full-time Benefits:

401(k) 401(k) matching Dental insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Vision insurance

Education:

High school or equivalent (Required)

Experience:

Medical terminology: 1 year (Preferred)

Customer Service:

1 year (Required)

Work Location:

In person