Our Claims Resolution Coordinators investigate and analyze accounts in order to properly identify and coordinate insurance benefits and resolve outstanding balances. Works closely with the patient as well as insurance carriers until the claim has reprocessed and payment has been issued.
PRIMARY DUTIES AND RESPONSIBILITIES MAY INCLUDE ANY OR ALL OF THE FOLLOWING:
- Perform daily tasks presented by manager such as account work, special projects, or requests
- Reach daily/monthly quota and/or goals
- Conduct online medical research using multiple online medical websites
- Contact patients by either phone or through letters
- Review medical records, provider notes, Explanation of Benefits, etc. for knowledge of appeal or account information
- Update claims system with updated accurate information
- Attend weekly denials meeting to discuss updates/changes such as new hospital procedures or current client issues
- Communicate any issues through the manager including, but not limited to, PTS errors, questions for other departments, HIPAA questions
- Stay up to date on state laws governing fee schedules, filling limits, and other statutes.
- Participate in special projects when presented by management or Partners
- Comply with company's code of conduct.
- Additional duties and responsibilities as assigned.
- Office environment with some exposure to external environment, temperature changes, uneven walking services.
- Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.
- Hearing: Able to hear average or normal conversations and receive ordinary information.
- Repetitive motion: Frequent and regular use of the wrists, hands, and fingers to make small movements such as typing or picking up small objects. Normal fine and gross motor control of fingers and hands.
- Seeing: Visual acuteness necessary for the proper evaluation of or to prepare, inspect documents or other materials. Ability to accurately view computer monitors.
- Physical: Frequent sitting, standing and walking. Occasional lifting up to 25 lbs, pushing and pulling up to 45 lbs. Occasional kneeling, stooping, and bending at the waist.
POSITION QUALIFICATIONS AND REQUIREMENTS:
- Bachelor's degree is preferred or comparable work experience or work experience and education
- Prior experience with insurance claims and/or a background in the legal profession is preferred but not required
- Prior experience in an administrative or clerical role in an office environment preferred
Knowledge, Skills, Abilities and Competencies:
- Minimum 45 WPM Typing and 6,000 KPH 10-key
- Consistent ability to work with a high volume of accounts
- Focused and self-motivated
- Excellent investigative and problem-solving abilities
- Close attention to detail and accuracy
- Ability to learn software systems
- Exceptional organization, time management, prioritization skills
- Ability to adapt to constantly changing environment/ well developed multitasking skills
- Exceptional written and verbal communication skills including grammar
- Ability to contribute in a positive manner
- Proficient using Microsoft office products such as Word, Excel, Outlook and Adobe Acrobat
- Knowledge of Healthcare Terminology preferred but not required
Posting ID: 595949147Posted: 2021-01-13