Claims Resolution Specialist

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

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