Claims Resolution Specialist
On-siteLafayette, Louisiana, United States
Lafayette, Louisiana, United StatesOn-siteFull TimeHigh School Or EquivalentMedium
Full TimeHigh School Or EquivalentMedium
Job Summary
Review and understand insurance policies, medical documentation, and Explanation of Benefits to resolve back collections, denial appeals, and payment reviews. Manage claims generation, answer patient and insurance carrier calls, and handle faxing and emails while maintaining effective communication with internal teams. Report concerns directly to the Revenue Cycle Manager and Supervisor, ensuring accurate adherence to Medicare, Medicaid, and HIPAA regulations. Utilize initiative to maintain consistent productivity and accuracy in processing claims and balance billing tasks.
Required Qualifications
- High School Diploma or equivalent
- Knowledge of Explanation of Benefits from insurance companies
- General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid
- Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits
- Enough knowledge of policies and procedures to accurately answer questions from internal and external customers
- Utilizes initiative while maintaining set levels of productivity with consistent accuracy
- Minimum of 1 year of insurance verification or authorizations
- Superior organizational skills
- Proficient in Microsoft Office, including Outlook, Word, and Excel
- Attention to detail and accuracy
- Effective/professional communication skills (written and oral)
Desired Qualifications
- 3-5 Years in DME or medical billing experience preferred
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