[Hiring] Claims Resolution Specialist @Innovaccer Analytics

Role Description

We at Innovaccer are looking for a Claims Resolution Specialist I (CRS-I). A successful Claims Resolution Specialist (Level-I) team member is responsible for processing medical claims within established best practices as defined by Caduceus standards, client specifics, and industry guidelines. Our client base consists of large-scale multi-specialty/multi-site healthcare organizations throughout the United States. The candidate will demonstrate a working knowledge of revenue cycle processes.

• Conduct AR Follow-up both on front end scrubs and back-end denials through best practices.
• Scrub charges for submission and launch appeals via the Athena billing platform.
• Review and clear claim edits in the system, including registration, insurance, charge, and related issues for high volume practices.
• Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers.
• Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
• Differentiating between best practices of appeal, coding review, credentialing review and/or adjustment.
• Contact insurance companies and utilize web portals and websites for appeal, eligibility, remittance, and payment information.
• Report and communicate issues and trends.
• Meet or exceed productivity expectations of a minimum average of 6 denials per hour (approximately 45 per day), while maintaining accuracy and quality standards.
• Highly productive and able to stay focused in a remote environment.
• Demonstrate mastery of the above essential functions with passing grades in a testing environment.
• Other duties as assigned.

Qualifications

• 3+ years of experience in claims resolution or medical billing.
• A minimum of 2 years of documented experience on the Athena billing platform is highly preferred.
• Additional EMR experience including Cerner, NextGen, and EPIC is a plus.
• Formal certification in medical billing preferred but not required.
• Working knowledge of CPT, ICD-10, and medical terminology.
• Complete understanding of follow-up processes.
• Solid background in AR and overall Revenue Cycle policies and procedures.
• Experience working in a medical billing environment where compliance with protected health information and HIPAA compliance is strongly enforced.
• Excellent communications skills.
• Excellent systems experience and acuity (EMR and Billing and Collection Systems).
• Proficiency in Microsoft Office Suite, including Word and Excel.
• Bachelor’s degree, medical billing certificate preferred.
• Ability to communicate orally and in writing in a clear and straightforward manner.
• Ability to communicate effectively with senior leadership and company personnel.
• Ability to effectively plan/manage/lead projects.
• Ability to make decisions and solve problems while working under pressure.
• Ability to prioritize and organize effectively.
• Ability to show judgment and initiative and to accomplish job duties.
• Ability to work independently.
• Strong business acumen.
• Effective communication skills including public speaking.

Requirements

• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
• Ability to sit for extended periods of time.
• Long periods of computer usage.
• Handling – seizing, holding, grasping and fingering of objects, tools and controls.
• Vision – close vision.
• Hearing - ability to receive detailed information through oral and telephonic communication.

Benefits

• Generous Paid Time Off: 20 days of fixed time off per year, in addition to company holidays.
• Best-in-Class Parental Leave: One of the industry’s most generous parental leave policies.
• Recognition & Rewards: Monetary incentives and company-wide recognition for your impact and dedication.
• Comprehensive Insurance Coverage: Medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance.
• Optional perks include discounted legal aid and pet insurance.