[Hiring] Claims Resolution Specialist @TELCOR

Role Description

The TRCS Claims Resolution Specialist is responsible for performing revenue cycle tasks for TELCOR Revenue Cycle Service customers. The Claims Resolution Specialist responsibilities include:

• Client billing
• Insurance billing
• Patient billing
• Accounts receivable

In addition, the Claims Resolution Specialist will demonstrate expertise in:

• RCM workflow
• Insurance policies and requirements including payer-specific policies
• Industry knowledge

Responsibilities

• Responsible for working claim rejections, payer rejections, and payer denials by performing analysis and investigation of individual scenarios.
• Identify commonalities or trends within current worklists or across future and past worklists to continuously improve quality, efficiency, and customer outcomes for TRCS Success.
• Follow up and take action by interpreting information, making determinations, applying knowledge, and executing appropriate next steps on payer rejections and denials.
• Responsible for follow-up on claims with no payer response after submission or resubmission.
• Adhere to requirements in accordance with Standard Operating Procedures or Best Practices.
• Determine when to bill a patient and when to assign work back to the customer for review.
• Escalate questions, errors, or setup changes to TRCS Revenue Cycle Supervisor.
• Follow up on claims with no payer response to facilitate payment or balance transfers.
• Demonstrate knowledge of CPT, HCPCs modifiers, ICD-10 codes, and EOB interpretation.
• Demonstrate knowledge of payer requirements, clearinghouse portal navigation, and appropriate interpretation of information.
• Meet with the TRCS team regularly to discuss issues, review team performance, and participate in ongoing training.
• Enhance business line organization and success by accepting ownership for accomplishing new requests.
• Demonstrate basic knowledge of other team member functions to execute Claims Resolution Specialist I job functions.
• Meet performance expectations set forth by supervisors and leadership team.
• Stay current on work assigned or delegated within established timelines.
• Demonstrate the ability to think analytically and apply strategy to use of and interaction with the RCM application.
• Demonstrate fluent knowledge of the RCM application.
• Serve as a resource to others for questions and direction.
• Claims Resolution Specialists may be assigned to areas of focus or specialization.
• Follow up on unpaid balances to obtain payment and submit reconsiderations or appeal letters as necessary.
• Additional duties may be assigned.

Qualifications

• Must be able to uphold confidentiality and comply with federal, state, and company policy, procedures, and regulations.
• Ability to effectively and professionally communicate, both in writing and verbally.
• Must be able to work independently and with a team.
• Must be able to apply critical thinking and appropriate discernment in all activities.
• Must possess creative thinking skills to develop solutions.
• Strong computer skills and ability to navigate technology (e.g., Excel, electronic documentation).
• Self-motivated, analytical, quick learner, organized, detail-oriented, multi-tasker, resilient, self-disciplined in time management.
• Understanding of the structure and key issues in the billing or revenue cycle environment.
• Thorough understanding of Windows® operating system environments and Office tools (e.g., Word®, Excel®).

Preferred Qualifications

• One or more years of healthcare billing or revenue cycle experience (laboratory billing a plus) or medical coding education preferred, but not required.

Company Description

TELCOR is a proven leader in healthcare software, delivering Point of Care (POC) middleware, Revenue Cycle Management (RCM) software, RCM managed billing services, and AI-driven solutions to hospitals, health systems, and independent laboratories nationwide.

TELCOR is Great Place to Work Certified®, and our core values — integrity, innovation, dedication, acceptance, passion, and collaboration — guide how we build products and work with one another.