Claims Resolution Specialist
Job Description
Job Description
Overview: Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.
- Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years.
- Conduct AR Follow-up both on front end scrubs and back end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
- Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
- Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
- Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
- Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
- Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
- Candidate must be able to report and communicate issues and trends.
- Meet or exceed daily productivity benchmarks.
Knowledge, Skill, and Experience Requirements:
- 3+ years of experience in claims resolution or medical billing.
- A minimum of 3 years of documented experience on the Athena billing platform is required.
- Working knowledge of CPT, ICD-10, and medical terminology.
- Complete understanding of follow-up processes.
- Solid background in AR and overall Revenue Cycle policies and procedures.
- Experience working in a physician billing environment.
- Excellent communication skills.
- Proficiency in Microsoft Office Suite, including Word and Excel.
Recommended Jobs
Trauma Surgery Physician Assistant
We are hiring a locum Physician Assistant for Trauma Surgery and SICU Step down coverage on the Famous Jersey Shore! The coverage is going from June - September with possibility of extending! Sched…
Physician Family Practice
About Us Cooper University Health Care is named as one of America’s Best Employers by Forbes , and one of only 30 companies in New Jersey to make the Forbes list. Cooper University Hospital, …
Service Technician
Job Description Job Description MIH Systems Group is a growing company in the evolving field of building commissioning, and we strive to make buildings work better. Specializing in the optimizat…
Occupational Therapist - Home Care
Job Description Job Description SportsMed Physical Therapy is a leading physical therapy practice in the Northeast. We are seeking Home Care Occupational Therapists to join our growing team. If y…
Cost & Control Analyst
Job Description Job Description Inventory Control & Cost Analyst Join a growth minded, family owned manufacturer, focus on building benchmark and custom Industrial Electronical Mechanical Wa…
Facility Apprentice
Job Description Job Description Position Summary The Facility Maintenance Apprentice is an entry-level position that provides hands-on training in facility and warehouse maintenance. Working a…
Senior Mechanical Project Manager (Traveling)
Job Description Job Description Senior Mechanical Project Manager (Traveling) Nationwide Projects | Full-Time Travel Required Confidential Opportunity – Partnered with a Leading Mechanical Con…
Direct Support Professional
Job Description Job Description Description: Schedule is evenings during the week 4:30pm-8:30pm (can be flexible). Weekend shifts available, day and evening shifts. 9-2pm & 2pm-8:30pm. Assistanc…
Associate Veterinarian - Ridgewood, NJ | Small Animal & Exotic Care Associate Veterinarian - Ridgewood, NJ | Small Animal & Exotic Care
We’re currently working with a growing veterinary practice in Ridgewood, New Jersey , that is seeking a full-time Associate Veterinarian to join a supportive, skilled team. The role offers the oppo…
Director, Market Access -- Trade Strategy
Job Description At Gilead, we’re creating a healthier world for all people. For more than 35 years, we’ve tackled diseases such as HIV, viral hepatitis, COVID-19 and cancer – working relentlessl…