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LymphaCare
Insurance Claims Resolution Specialist
Career Insights for Claims Adjuster / Specialist (General)
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Based on Pennsylvania data
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What they do
A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
$76,225 / year median in Pennsylvania
+2% projected growth
Job Description
Job description: LymphaCare, a leading provider of top-of-the-line products for treating wounds and lymphedema, is looking for an experienced Insurance Claims Resolution Specialist. The Insurance Claims Resolution Specialist role is heavily involved in ensuring all claims are processed with payment. Essential Job Duties Review and analyze DME insurance claims for accurate reimbursement Identify reasons for denials, such as missing documentation, incorrect coding, or eligibility issues, etc. Prepare and submit appeal letters or corrected claims in accordance with payer guidelines. Monitor and track appeals and claim status to ensure timely resolution. Collaborate with referral sources, internal staff, and external contacts to gather necessary documentation. Stay updated on payer policies and changes in DME coverage and billing guidelines. Document all obtained information Abide by HIPAA regulations and standards as well as regulatory requirements Requirements A/R and Denials experience required Excellent written, verbal, and mathematical skills Top notch organizational and multitasking skills Ability to work independently as well as collaborate with the team Desire to work in a fast paced / high productivity environment at an innovative and dynamic company Experience in an insurance-related field (i.e, medical billing, insurance verification, DME company, health plan) Knowledge and understanding of common insurance terms: copay, deductible, coinsurance, in and out of network, referral, and prior authorization Brightree experience is a plus