Account Resolution Specialist III - HB / PB

We are hiring in the following States:
AZ, CA, CO, CT, FL, GA, HI, MA, ME, MN, MO, NV, OK, PA, SD, TN, TX, WA

This is a remote position. Candidates who meet the minimum qualifications will be required to complete a video prescreen to move forward in the hiring process. 

Hourly Rate: $21.00 - $23.00

Benefits: PTO, 401K, medical, dental, vision, life insurance, paid holidays, and more

Ensure continuation of revenue flow by overseeing proper claim submission and payment through review and correction of claim edits, errors and denials. Act as SME for account resolution for physician claims (CMS-1500), as well as payment for hospital claims through review and correction of claim edits, errors, and denials. Utilize review and payer guidelines. Work with all client teams.
 

• Perform tasks to generate revenue through account resolution for any Company client.
• Work with clients across Flex Workforce organization.
• Resolve escalated and/or stalled claims.
• Provide training and support to ARS Is and ARS IIs to improve quality and productivity.
• Mentor ARS Is and ARS IIs to increase skill levels.
• Submit claims in accordance with Federal, State, and payer mandated guidelines.
• Comply with productivity standards while maintaining quality levels.
• Responsible to research, analyze, and review claim errors and rejections and make applicable corrections.
• Ensure that claims submitted to payers are not returned nor denied due to controllable error.
• Maintain required knowledge of payer updates and process modifications to ensure accurate claims.
• Investigate, follow up with payers, and collect on insurance accounts receivables.
• Verify that accounts display accurate liability and balance with payer.
• Identify any payer specific issues and communicate to team and manager.
• Perform operations workflow training for new hires
• Perform quality audits during training for new hires
• Participate and contribute to daily shift briefings.
  Qualifications
• Bachelor’s degree in Revenue Cycle Management or related field preferred.
• 3-5 years of experience working with health insurance companies in securing payment for medical claims.
• 3-5 years of experience with hospital and physician claim follow up and appeals with health insurance companies.
• Experience with multiple systems, e.g., Epic preferred.
• Expertise with computer including Microsoft Office Suite/Teams and GoToMeeting/Zoom, etc.
   
  

  Knowledge, Skills, and Abilities

• Knowledge of ICD-10 Diagnosis and procedure codes and CPT/HCPCS codes
• Knowledge of rules and regulations relative to Healthcare Revenue Cycle administration
• Skilled in medical accounts investigation.
• Skilled in achieving results with little to no oversight.
• Skilled to investigate and resolve escalated claims
• Skilled in research to identify new rules and regulations relative to Healthcare Revenue Cycle administration
• Ability to validate payments
• Ability to make decisions and take action.
• Ability to maintain a positive outlook, pleasant demeanor, mature nature during all interactions, and act in the best interest of the organization and the client.
• Ability to take professional responsibility for quality and timeliness of work product.