Insurance Claims Resolution Specialist - Patient Accounting - FT 1.0 (80 hrs biweekly) (57044)

Job Details

Job Location: Reno, OH

Position Type: Full Time

Salary Range: Undisclosed

Job Shift: 8-Hour Day Shift

Description

In an environment of continuous quality improvement, the Insurance Claims Resolution Specialist serves as the subject matter expert of claims management with the insurance payers on behalf of their subscribers that present to Memorial Health System for their health care needs. Serves as a liaison to validate claims process and reimburse based on policy provisions promptly and at the negotiated contracted rate per contract terms. Responsible for evaluating and analyzing insurance payer performance and identifying denial trends. Exhibits the Standards of Excellence and always exercises strict confidentiality.

Job Functions

• Review and analyze insurance claims to identify payment delays or denials caused by insurance companies.
• Conduct thorough investigations and gather necessary documentation to support claims resolution.
• Communicate directly with insurance companies to resolve claim issues, including payment delays and denials.
• Advocate for patients by presenting compelling arguments, evidence, and supporting documentation to insurance companies to ensure fair and timely claim settlement.
• Collaborate with internal teams, such as medical billing and legal departments, to gather additional information and support claims resolution efforts.
• Stay updated on insurance industry regulations, policies, and procedures to navigate claim resolution processes effectively.
• Maintain accurate and detailed records of claim activities, correspondence, and outcomes.
• Provide guidance and support to patients and the revenue cycle departments, explaining the claim resolution process and addressing any concerns or questions they may have.
• Collaborate with healthcare providers and medical professionals to obtain necessary medical records and documentation for claim resolution.
• Proactively identify trends and patterns in claim denials or payment delays and develop strategies to prevent future issues.
• Maintain effective relationships with our contracted payers including facilitating regular scheduled meetings and troubleshooting claim issues.
  
  

Qualifications

Minimum Education/Experience Required:

• High school diploma or GED required.
• Bachelor’s degree in healthcare administration, business, or a related field is preferred.
• Minimum of three years of relevant experience required.
• Experience in insurance claims resolution, healthcare billing, or related fields preferred.
• In-depth knowledge of health insurance processes, policies, and procedures preferred.
• Familiarity with medical terminology and coding systems (e.g., CPT, ICD-10) preferred.
  
  

Special Knowledge, Skills, Training

• Strong negotiation and communication skills, with the ability to advocate effectively on behalf of patients.
• Excellent attention to detail and analytical skills to review and interpret complex insurance policies and claims.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
• Proficient in using computer systems and software applications related to claims processing and documentation.
• Strong problem-solving skills; strong computer skills; fluent in Excel and PowerPoint; manual dexterity, color vision, and near visual acuity.
  
  

Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended.

Benefits: Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at www.mhsystem.org/benefits.

Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.

Memorial Health System is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at https://www.ocio.usda.gov/document/ad-3027, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

• Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.