Claims Resolution Specialists II
Core
Review medical insurance claims, resolve denials, and obtain appropriate payments for oncology and related specialties.
Role type
Claims Resolution Specialist
Builds
Insurance claim resolutions and payment collections for medical oncology/hematology/radiology services
Domain
Healthcare / Medical Billing & Collections
Deliverable
client delivery
Required skills
Medical billing and collections, Insurance carrier billing and reimbursement, Medical terminology, ICD-9/ICD-10/CPT codes, Explanation of benefits (EOB), Electronic Medical Records (EMR), GE Centricity Practice Management software, Medical Oncology/Hematology/Radiology/Pathology knowledge
Preferred skills
Experience in Medical Oncology/Hematology/Radiology/Pathology/Pumps/Specialties, GE Centricity Practice Management software
Technologies
Onco EMR, Centricity, Unity
Responsibilities
Review medical insurance claims for resolution and obtain appropriate payment, Resolve incoming inquiries and denials from various entities, Contact insurance carriers to research and respond on open account balances, Respond to patient and office inquiries regarding outstanding insurance balances and payments, Manage insurance review and denial of payment by responding with appropriate documentation to support appeal, Follow-up on claims to ensure payment was received, Transfer appropriate balances to patient responsibility and notify relevant departments, Bill applicable secondary insurance, Document all collection activity in EMR systems, Contact patients to correct insurance information, Maintain confidentiality of patient and employee information per HIPAA
Seniority
Entry-level, hands-on IC