Claims Resolution Specialist

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Innovaccer

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2014

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $150M Series E on 2021-12

Healthcare • Consulting • Logistics

Innovaccer is a healthcare technology company dedicated to transforming how healthcare information is utilized and accessed. They provide a comprehensive Health Cloud that aims to accelerate digital transformation for providers, payers, and life sciences companies by offering unified healthcare data and analytics. Innovaccer leverages artificial intelligence to automate tasks, process medical data, and generate insights to improve clinical and financial outcomes. Their solutions focus on integrating and optimizing healthcare systems, promoting value-based care, improving patient engagement, and reducing the administrative burden on healthcare providers. Innovaccer's platform supports various healthcare stakeholders through advanced data activation, analytics, and streamlined workflows, striving to improve healthcare delivery and patient care globally.

📋 Description

• Process medical claims according to Caduceus standards, client requirements, and industry guidelines • Conduct accounts-receivable follow-up on front-end scrubs and back-end denials • Scrub charges for submission and launch appeals through the Athena billing platform • Review and clear registration, insurance, charge, and related claim edits for high-volume practices • Read and interpret EOBs and denials from all insurance carriers, including co-pays, deductibles, and co-insurance • Process appeals end to end across all payer categories • Differentiate between appeal, coding review, credentialing review, and adjustment best practices • Contact insurance companies and use web portals for appeal, eligibility, remittance, and payment information • Report and communicate issues and trends • Meet or exceed productivity expectations of at least 6 denials per hour, approximately 45 per day, while maintaining accuracy and quality • Demonstrate mastery of essential functions in a testing environment • Perform other duties as assigned

🎯 Requirements

• 3+ years of experience in claims resolution or medical billing • Minimum of 2 years of documented experience on the Athena billing platform highly preferred • Additional EMR experience including Cerner, NextGen, and EPIC is a plus • Ability to pass skills test on the platform • 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 accounts receivable and revenue cycle policies and procedures • Experience in a medical billing environment with protected health information and HIPAA compliance • Excellent communication skills • Experience with EMR, billing, and collection systems • Proficiency in Microsoft Office Suite, including Word and Excel • Bachelor's degree or medical billing certificate preferred • Ability to communicate clearly orally and in writing • Ability to communicate effectively with senior leadership and company personnel • Ability to plan, manage, and lead projects • Ability to make decisions and solve problems under pressure • Ability to prioritize and organize effectively • Ability to demonstrate judgment and initiative • Ability to work independently • Strong business acumen • Effective communication skills, including public speaking • Ability to lift and move approximately 30 pounds on a non-routine basis • Ability to sit for extended periods and use a computer for long periods • Ability to handle, seize, hold, grasp, and finger objects, tools, and controls • Close vision • Ability to receive detailed information through oral and telephonic communication • Employment eligibility verification required for employees based in the United States

🏖️ Benefits

• 20 days of fixed paid time off per year, in addition to company holidays • Generous parental leave • Monetary incentives and company-wide recognition • Medical, dental, and vision insurance • 100% company-paid short- and long-term disability insurance • 100% company-paid basic life insurance • Discounted legal aid • Pet insurance • Remote work environment

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