Claims Resolution Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Process medical claims in accordance with Caduceus standards, client specifications, and industry regulations.

• Conduct follow-up on accounts receivable concerning front-end scrubs and back-end denials.

• Scrub charges for submission and initiate appeals using the Athena billing platform.

• Review and resolve registration, insurance, charge, and related claim edits for high-volume practices.

• Analyze and interpret EOBs and denials from all insurance providers, including co-pays, deductibles, and co-insurance.

• Manage appeals from start to finish across all payer categories.

• Distinguish between appeal, coding review, credentialing review, and best practices for adjustments.

• Engage with insurance companies and utilize web portals for obtaining appeal, eligibility, remittance, and payment details.

• Report and communicate any issues and trends identified.

• Meet or exceed productivity targets of at least 6 denials per hour, which amounts to approximately 45 per day, while ensuring accuracy and quality.

• Showcase proficiency in essential functions within a testing environment.

• Perform additional duties as required.

⛳️ Requirements

• Over 3 years of experience in claims resolution or medical billing.

• At least 2 years of documented experience using the Athena billing platform is highly preferred.

• Additional EMR experience with Cerner, NextGen, and EPIC is an advantage.

• Capability to pass a skills assessment on the platform.

• Formal certification in medical billing is preferred but not mandatory.

• Strong understanding of CPT, ICD-10, and medical terminology.

• Comprehensive knowledge of follow-up processes.

• Solid foundation in accounts receivable and revenue cycle policies and procedures.

• Experience working in a medical billing environment that handles protected health information and adheres to HIPAA compliance.

• Excellent verbal and written communication skills.

• Familiarity with EMR, billing, and collection systems.

• Proficiency in Microsoft Office Suite, particularly Word and Excel.

• A bachelor's degree or a medical billing certificate is preferred.

• Ability to communicate clearly, both verbally and in writing.

• Effectively communicate with senior leadership and company personnel.

• Capability to plan, manage, and lead projects.

• Competence in making decisions and solving problems under pressure.

• Ability to prioritize and organize tasks effectively.

• Exhibit good judgment and initiative.

• Work independently with minimal supervision.

• Strong business acumen.

• Effective communication skills, including public speaking abilities.

• Physical ability to lift and move approximately 30 pounds occasionally.

• Capability to sit for extended durations and use a computer for long periods.

• Ability to handle, grasp, and manipulate objects, tools, and controls.

• Clear vision for detailed tasks.

• Ability to receive detailed information through oral and telephonic communication.

• Employment eligibility verification is required for employees located in the United States.

🏝️ Benefits

• 20 days of fixed paid time off each year, in addition to company holidays.

• Generous parental leave policy.

• Financial incentives and company-wide recognition programs.

• Medical, dental, and vision insurance coverage.

• 100% company-paid short- and long-term disability insurance.

• 100% company-paid basic life insurance.

• Access to discounted legal aid services.

• Pet insurance options available.

• Flexible remote work environment.