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Claims Resolution Specialist

Claims Resolution Specialist

Sleep Management, LLCLafayette, LA, US
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Job Description

Job Description

­­­­­­­­­­­­­­­­­­­ Duties :

  • Review and understand Insurance policies and standard Explanation of Benefits.
  • Review and understand medical documentation effectively
  • Review and resolve Back Collections related tasks, such as

Denial appeals

  • Payment review and balance billing
  • Claims generation
  • Establishes and maintains effective communication and good working relationships with insurance carriers, patients / family, and other internal teams for the patient’s benefit.
  • Performs other clerical tasks as needed, such as
  • Answering patient / Insurance calls

  • Faxing and Emails
  • Communicates appropriately and clearly to Manager / Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
  • Other responsibilities and projects as assigned.
  • Requirements :

  • High School Diploma or equivalent
  • Knowledge of Explanation of Benefits from insurance companies
  • General knowledge of government, regulatory billing and compliance regulations / policies for Medicare & Medicaid
  • Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
  • Enough knowledge of policies and procedures to accurately answer questions from internal and external customers.
  • Utilizes initiative while maintaining set levels of productivity with consistent accuracy.
  • Experience :

  • 3-5 Years in DME or medical billing experience preferred.
  • Minimum of 1 year of insurance verification or authorizations required.
  • Skills :

  • Superior organizational skills.
  • Proficient in Microsoft Office, including Outlook, Word, and Excel.
  • Attention to detail and accuracy.
  • Effective / professional communication skills (written and oral)
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    Resolution Specialist • Lafayette, LA, US