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Claims Resolution Specialist - Carrier Relations
Claims Resolution Specialist - Carrier RelationsMedlytix • Roswell, GA, US
Claims Resolution Specialist - Carrier Relations

Claims Resolution Specialist - Carrier Relations

Medlytix • Roswell, GA, US
9 days ago
Job type
  • Full-time
Job description

Job Description

Job Description

JOIN OUR GROWING CLAIMS DEPARTMENT AT MEDLYTIX!

The Claims Resolution Specialist plays a key role in resolving open receivables for our clients.

You will process medical (physician and hospital) bills that involve motor vehicle accidents, workers' comp, and third-party claims. The Claims Resolution Specialist will work toward increased reimbursement and account resolution.

Responsibilities :

  • Works independently to identify issues with claim submissions; identifies corrective steps; follows issue through to resolution.
  • Provide exceptional customer service for inbound calls.
  • Interface with insurance agents, patients, and others to the disposition of each account.
  • Identify obstacles to claim submission and payment, including updating insurances, adjuster contact information, submitting bills, and providing requested documentation.
  • Identify patterns with payers that result in non-payment or delayed payment. Ability to summarize and escalate in the correct manner.
  • Update accounts in our proprietary technology platform to increase probability of collection and resolution of accounts.
  • Rely on experience and judgment as well as instructions and pre-established guidelines to plan and accomplish goals and perform a wide variety of tasks.

Required Skills :

  • Experience in healthcare revenue cycle, particularly physician billing, claims resolution, and customer service.
  • Understanding and concern for patient privacy and HIPAA compliance
  • Ability to interpret payer EOBs and understanding of coordination-of-benefits concepts.
  • Excellent customer service, verbal and written communication skills
  • Ability to review and interpret account information to successfully resolve account issues.
  • Attention to detail in identifying, comparing & transferring data (particularly numbers)
  • Ability to effectively navigate multiple systems to download & transfer files.
  • Ability to research & follow written guidelines to determine next steps when conflicting information is presented
  • Ability to identify trends / issues and communicate these to supervisors.
  • Basic-to-Intermediate Microsoft Excel Skills
  • Excellent Data Entry Skills

    • Education and Experience :

  • Bachelor's degree preferred, High School diploma or GED required
  • Health Information Management credential (RHIA, RHIT, CAHIMS, CPHIMS) preferred
  • 2+ Years of Healthcare Revenue Cycle Experience
  • Inbound Call Center Experience
  • Preferred bilingual - fluent in speaking Spanish
  • Preferred prior experience as team-lead, supervisor, or manager

    • Other relevant info :

  • Full Time position - Remote available in northeast Ohio or Tennessee
  • Full Time position - In office - Location : Roswell, GA 30076

    • Why Medlytix ?

  • Competitive Pay
  • Competitive Paid Time Off
  • Comprehensive Medical, Dental, Vision and 401K Packages
  • Family Support Benefits
  • Paid Company Holidays

    • As part of our commitment to quality and excellence, Medlytix will continue to maintain a safe and healthy environment for you by requiring all applicants to submit to a criminal history check and those tentatively selected for a position to submit to screening for illegal drug use prior to appointment for a job. In addition, applicants may be screened for ability to perform essential functions of some positions.

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    Resolution Specialist • Roswell, GA, US