Claims Resolution Specialist

Role Overview

This position is responsible for contacting healthcare providers to discuss negotiations for a specific dollar range of eligible claims/bills prior to payment, in order to achieve maximum discounts and savings on behalf of payor/client. The role involves managing a high volume of healthcare claims, performing provider research, addressing counteroffers, and updating provider data base for reference and claims processing.

What You Will Do

Manage a high volume of healthcare claims, perform provider research, address counteroffers, update provider data base, initiate provider telephone calls, and meet established departmental performance metrics.

Why It Might Be a Fit

This role requires strong communication, negotiation, and organizational skills, as well as the ability to work independently and handle confidential information. The ideal candidate will have a minimum of 6 months experience in the healthcare industry and a high school diploma or GED.

Requirements

• Minimum high school diploma or GED
• Minimum 6 months experience in the healthcare industry (provider billing, medical coding, provider collections, insurance, or managed care); 1 year preferred
• State licensure certification, including NY Health and/or P&C State Adjustor license, may be required
• Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers’ Compensation or automobile medical (‘auto’) bills a plus
• Knowledge of general office operations and/or experience with standard medical insurance claim forms
• Good Communication (verbal, written and listening) teamwork, negotiation, and organizational skills
• Ability to process verbal and written instructions
• Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software

Benefits

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• Paid Parental Leave
• 401(k) + match
• Employee Stock Purchase Plan
• Generous Paid Time Off – accrued based on years of service
• 10 paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year

Originally posted on Himalayas