Claims Resolution Specialist 1 - USFTGP UMSA RCO Back End

Responsible for prompt and accurate submission and follow-up of all third party claims. Reviews assigned accounts perform status inquiry and appeals to 3rd party payers to ensure reimbursement. Reviews assigned accounts, determines appropriate action to resolve outstanding balances. Works within the established guidelines of the department’s procedures, policies and goals. Conduct studies/special projects to resolve outstanding accounts receivables.

QUALIFICATIONS:
Required: • High School Diploma Work Experience and Additional Information • 2 years experience in physician billing and collection experience preferred • CPT ICD9 experience • IDX Software preferred Essential Functions • Contact payers regarding outstanding claim status and determine appropriate action for swift resolution of outstanding claims • Process appeals and claim resubmissions per payer policy and identify any trends that may allow for a front end edit to be put in place to assist with clean claim filing • As a Senior Claims Specialist, you will be expected to provide assistance to coworkers on the floor ensure all are supported in their daily functions • Responsible for 2nd/3rd level appeals for any and all payers, making certain documentation being sent includes all necessary items to support our claim • Stay current on carrier guidelines, as well as State and Federal regulations