Claims Resolution Representative

POSITION: Claims Resolution Representative LOCATION: Remote (U.S. only). Candidates must reside outside of California, Oregon, Colorado, Maine, New York, New Jersey, and Virginia. Applicants residing in these states will not be considered. DEPARTMENT: Billing REPORTS TO: Revenue Cycle Manager JOB SUMMARY : Responsible for follow-up on outstanding claims, researching claim denials, composing and submitting appeals, and handling any necessary claim correspondence necessary to have a claim processed. EDUCATION AND EXPERIENCE: · High school diploma or equivalent · Coding Certification Preferred · Two years minimum experience in Surgery claims resolution required. · Knowledge of medical and insurance terminology. · Ability to read and interpret payer remittance advice. · Nextech knowledge is preferred. · Strong organizational skills and attention to detail. · Strong analytical and critical thinking skills. · Ability to handle large volume of claims. · Ability to communicate effectively with patients ESSENTIAL SKILLS AND ABILITIES: · Review and process incoming claims in a timely and accurate manner · Investigate claim denials by gathering relevant documentation and information · Determine appropriate resolutions based on company guidelines and policies · Ability to navigate payer websites and upload documentation · Understanding of medical terminology and coding · Ability to navigate EMR to locate any needed documentation · Knowledge in Microsoft Office (Word, Excel) RESPONSIBILITIES: · Complete assigned tasks to meet productivity requirements for claims resolution and complete any progress in worklog tasks · Stay current with insurance payer policies as well as state and federal regulations for claim submission and reimbursement. · Examine any overpayments to determine if monies need to be returned to payer or patient · Document all follow-up calls and research clearly in task notes. · Compose appeal letters where needed and complete any payer forms required for submitting the appeals. · Observance of all HIPAA guidelines and regulations, as well as rules governing PHI. · Review all denials for patterns and trends · Monitor Ebridge for any payer correspondence or record requests. · Work with clinical team to resolve coding denials. · All other duties as assigned PHYSICAL DEMANDS: Must be able to talk on the phone to staff, leaders, physicians, and patients. Must be able to work in different conditions (different noise levels, lighting levels, be able to stoop, bend, reach and lift up to 25lbs).