Claims Resolution Specialist

🕒 Julho 10

🌵 Arizona, California, +5 estados a mais – Remoto

🌵 Arizona – Remote 🏄 California – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ☕ Washington – Remote

💵 $28 - $35 / hora

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

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Boomerang Healthcare

SiteLinkedInTodas as Vagas

201 - 500 funcionários

💼 Consultoria

⚖️ Jurídico

🏥 Saúde

Consulting • Legal • Healthcare

Boomerang Healthcare é um site inicial ou temporário para uma empresa que parece operar no setor de saúde. O site atualmente exibe uma mensagem de "em breve" e não fornece informações públicas sobre serviços, produtos ou clientes-alvo, portanto atividades específicas (por exemplo, seguros, recrutamento, software) não podem ser determinadas a partir do conteúdo disponível. O negócio provavelmente está desenvolvendo ou se preparando para lançar sua presença online.

Descrição

• Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission • Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues • Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate • Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines • Perform payer research and communicate directly with insurance carriers to resolve claim processing issues • Monitor assigned work queues and ensure timely resolution of outstanding claims • Escalate complex reimbursement, coding, or compliance issues to senior team members • Partner with A/R and Denials Management teams to resolve denied and underpaid claims • Assist in preparing appeal documentation and supporting materials for denied claims • Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator • Maintain accurate documentation of denial resolution activities and payer communications • Support efforts to reduce preventable denials and improve reimbursement outcomes • Work closely with the pre-billing team to identify and correct claim issues prior to submission • Review claims for completeness and compliance with payer billing requirements • Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage • Collaborate with coding and clinical teams to obtain information needed for claim resolution • Assist with reducing claim holds and billing delays • Participate in routine claim quality reviews and internal audit activities • Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines • Support Revenue Integrity initiatives through accurate claim review and documentation • Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements • Adhere to HIPAA, CMS, and organizational compliance standards • Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities • Track assigned workloads and resolution outcomes • Assist with compiling information for denial trend reporting and operational reviews • Provide feedback regarding workflow issues contributing to claim errors or payment delays • Assumes other responsibilities as appropriate to the position and organizational needs

🎯 Requisitos

• High School Diploma or equivalent required • Associate degree in Healthcare Administration, Medical Billing and Coding, or related field preferred • Minimum 2-4 years of experience in medical billing, claims resolution, denial management, accounts receivable, or healthcare revenue cycle operations • Working knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial insurance billing requirements • Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical terminology • Experience researching and resolving denied or rejected claims • Strong analytical and critical thinking skills • Ability to manage multiple priorities and meet productivity expectations.

🏖️ Benefícios

• Amazing work/life balance • Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO) • 401(K) Plan with Employer Matching • License & Tuition Reimbursements • Paid Time Off • Holiday Pay & Floating Holiday • Employee Perks and Discount Programs • Supportive environment to help you grow and succeed