Claims Resolution Specialist

We are looking to add more Claims Resolutions Specialist to our team! Are you interested in getting your career started in the Behavioral Health industry?

JOB PURPOSE: Ensures Quality Control in utilization of policy benefits, verification of benefits, EOB analysis and liaison between clinical department and business counterpart.

JOB DUTIES AND RESPONSIBILITIES:

• Spends 6-8 hours of day making claims calls. 
• Spends hold times writing appeals or basic statusing claims using provider portals. 
• Conducts claim follow up/ denial resolution every 2 weeks minimum per claim.
•  Ensures complete accuracy of information gathered. 
• Ensures accurate reimbursement for contractual agreements and patients responsibility amounts. 
• Exhausts all options before writing appeals to overturn any claim denials.
•  Communicates actions that need to be taken to process claims to supervisor using Jira. 
• Communicates claim payments issued by check, EFT, or VCC to supervisor using Jira. 
• Communicates department needs to supervisor. 
• Communicate with BPO agents regarding necessary claims escalations. 
• Maintains up to date knowledge of insurance payer requirements. 
• Assists in training new hires.