Resolution Analyst, Denials
NationwideFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years’ experience in healthcare field working in billing or collections; 1+ years’ client facing/customer services experience.
- Required Skills
- MS Office
Requirements
- High School Diploma or GED required; Associates or Bachelor’s Degree preferred.
- 5+ years of experience in the healthcare field working in billing or collections.
- 1+ years of client-facing or customer service experience.
- Intermediate understanding of insurance payer/provider claims processing.
- Strong computer proficiency in MS Office (Word, Excel, Outlook).
- Intermediate knowledge of ICD, HCPCS/CPT coding, and medical terminology.
- Strong understanding of the revenue cycle process.
- Full understanding of hospital reimbursement and Managed Care contract language.
- Familiarity with HMO, PPO, IPA, and capitation terms.
- Intermediate understanding of EOB and hospital billing forms (UB04, HCFA 1500).
- Ability to review client/payer contracts to identify complex underpayments.
Responsibilities
- Review, evaluate, appeal, and follow up on outstanding, denied, and underpaid claims using proprietary software.
- Use payment documentation and provider contract information to determine correct reimbursement.
- Identify and collect cash payments from insurance companies by reviewing hospital contracts.
- Research and acquire medical records to submit complex underpayment appeals.
- Conduct telephone follow-up with payers to ensure timely claim resolution.
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