Claims Resolution Specialist

Order Type : Temp

General Description The basic function of the Reimbursement Specialist is to analyze the billing process to determine appropriateness in payment (reimbursement). This position is responsible for handling all components of claims processing including coordination of disputed, rejected and delayed claims and to review returned, disputed or rejected claims from Medicare, Medicaid and other third-party payers and problem solve. This position is responsible for communicating and training other departmental staff regarding revenue cycle processes to prevent future denials This class works under general supervision, independently developing work methods and sequences. Duties and Responsibilities The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary. • Provides technical assistance to members of other departmental staff. • Reviews remittances and determines reasons for denial or underpayment. • Works with TMHP, Medicare, and all other Insurance Companies in order to resubmit claims for maximized reimbursement. • Reviews and updates account receivables database and takes appropriate action regarding any unbilled, denied, or underpaid claims. • Reports and reconciles all unbilled, denied and underpaid claims. • Recommends to Supervisor which accounts should be written off and ensures write off process has been followed • Assists Chief Financial Officer with special billing reports as required. • Responsible for validating appeal opportunities, creating appeal letters, generating and submitting individual and/or batch appeals in a timely manner, tracking appeals and recoveries. Follow up on outstanding appeals, working closely with the appropriate teams to validate contracts, and verifying credentialed status. • Attends all workshops offered in the area for Medicaid, Medicare and/or Managed Care Organizations as well as any webinars provided. • Provides updated information to supervisor regarding any changes in fee schedule, procedure codes, contact information and/or limitations of benefits. ****SUBMIT RESUME TO Gloriad@rmpersonnel.com ****