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

Work assigned holds and worklists to resolve denials, takebacks, and credits
Communicate with insurance companies, patients, and providers to facilitate claim processing and payment
Review and appeal denied or unpaid claims
Contact payers to address discrepancies in payments
Follow insurance policies, payer rules, and CMS guidelines
Complete rebill projects and manage daily billing reports
Verify patient insurance coverage and update claims and charts accordingly
Review bills for accuracy, completeness, and missing information
Respond to patient inquiries regarding billing, insurance, and payments
Serve as a primary billing resource for practice staff

Requirements

JOB REQUIREMENTS

High school diploma or GED required
Previous experience in medical billing or a related field preferred
Proficiency with electronic health records and billing software preferred
Experience with Athena is preferred