Account Resolution Specialist - Insurance HMOs
New
D
DigitechEMS Billing
United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Required Skills
- Microsoft Excel
Requirements
- High School Diploma or equivalent required
- Strong computer skills, including working knowledge of MS Outlook, Word, and Excel
- Ability to type 40 WPM with accuracy
- Proven ability to handle high volume workloads, prioritize effectively, and meet tight deadlines
- Strong verbal communication skills for phone interactions with insurance carriers
- Excellent written communication skills for crafting clear documentation and correspondence
- Exceptional attention to detail in reviewing claims and identifying discrepancies
- Highly organized, self paced, and capable of managing work independently in a remote environment
Responsibilities
- Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by commercial insurance carriers
- Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow up actions to release claims for processing
- Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmission
- Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims
- Prepare and submit additional documentation requested by insurance carriers to support claim adjudication
- Draft and submit appeals when necessary, ensuring they are supported by proper documentation
- Maintain accurate, detailed notes in billing systems for all follow up activities
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