Job Description:
JOB SUMMARY
The Claims Resolution Specialist is responsible for ensuring accurate and timely billing and reimbursement for medical services. This role requires strong knowledge of medical terminology, coding, insurance processes, and billing procedures. The specialist will work closely with insurance companies, patients, and healthcare providers to resolve claim issues, address denials, and support the overall revenue cycle process.
JOB RESPONSIBILITIES
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Work assigned holds and worklists to resolve denials, takebacks, and credits
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Communicate with insurance companies, patients, and providers to facilitate claim processing and payment
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Review and appeal denied or unpaid claims
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Contact payers to address discrepancies in payments
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Follow insurance policies, payer rules, and CMS guidelines
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Complete rebill projects and manage daily billing reports
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Verify patient insurance coverage and update claims and charts accordingly
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Review bills for accuracy, completeness, and missing information
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Respond to patient inquiries regarding billing, insurance, and payments
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Serve as a primary billing resource for practice staff
JOB REQUIREMENTS
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High school diploma or GED required
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Previous experience in medical billing or a related field preferred
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Proficiency with electronic health records and billing software preferred
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Experience with Athena is preferred