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Medical Claims Payment Resolution Specialist

Company: Venteon
Location: Royal Oak
Posted on: January 8, 2022

Job Description:

Our Health Care client in Royal Oak, MI needs to hire a Medical CLAIMS PAYMENT RESOLUTION SPECIALIST (BILLING) that is talented in getting claims resolved and paid. Seeking an individual with a positive track record that enjoys this type of work.
Work in a shared services environment supporting a specific client base.

POSITION TYPE: Full Time. Direct Hire. Ability to work hybrid schedule after training period is complete.
PAY: $38,000 to $48,000 Annual (depending on experience) plus benefits package and paid time off.

Job Requirements:
DUTIES
--- Follow up on claims that have already been submitted for payment by the claims entry team and that either are denied or rejected by insurance companies.
--- Follow documentation to understand specific reason for denial of payment. Provide information that is incomplete or incorrect. Be aware of patient's diagnosis and specific coding relative to that diagnosis that is billable/collectible.
--- Support assigned clinics by conducting practice reviews and analysis. Obtain information relative to patient's condition/diagnosis/coding that applies to rejected billing to re-bill correctly.
--- Document and follow-up entries on patient accounts.
--- Operate medical billing software programs.
--- Use strategy and tact with insurance companies to resolve accounts.
--- Effectively communicate patient and clinical issues
--- Work to reduce then maintain 10% or less 120+ receivables
--- Working denials and rejections in a timely manner providing a follow up within 48 hours.
--- Represent multiple practices in a professional and positive manner
--- Effectively communicate with staff and management.

EDUCATION AND EXPERIENCE
--- High School diploma. Any additional health care education a plus.
--- 3 years previous health care claims processing experience.
--- Minimum 2 years work experience handling rejected and/or denied claims collection activities. Ability to problem solve and escalate issues as appropriate.
--- Experience with Internal Medicine/Family Practice, Pain Management, Oncology, or Addiction Medicine areas of treatment a plus.
--- Ability to navigate Insurance company websites to submit and query claims is required.
--- Experience with IVR -Integrated Voice Response required. (Navigating phone options to obtain info from Insurance companies).
--- Ability to pass a background check and drug screen.
--- Must be fully vaccinated prior to start (Mandated due to health organization)

Keywords: Venteon, Royal Oak , Medical Claims Payment Resolution Specialist, Healthcare , Royal Oak, Michigan

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