Prairie Ridge Health is seeking a Claims Resolution Specialist to join the Business Services team. This position is a 1.0 FTE (40 hours per week) and works a Monday-Friday, day shift schedule. The Claims Resolution Specialist is responsible for researching and resolving complex facility and professional insurance denials and ensures that claims are followed up in a timely manner....

Position Description:

The Claims Resolution Specialist is responsible for researching and resolving complex facility and professional insurance denials and ensures that claims are followed up in a timely manner. This position also requires corresponding with other teams on various types of errors to resolve claims needing additional review. They independently review accounts and apply billing follow up knowledge required for all insurance payors to insure proper and maximum reimbursement.  Uses multiple systems to resolve outstanding claims according to compliance guidelines. This role supports the revenue cycle workflows, charge capture, and work queue processes. This position will help optimize the Revenue Cycle by evaluating, validating, and trending data for presentation to all levels of the organization. 

EDUCATION EQUIREMENTS/LICENSURE/CERTIFICATION/REGISTRATION    

• High school diploma (or equivalent) required.

• 1-3 years of Medicare and Commercial billing in a hospital and/or clinic setting required. 

• Certified Professional Biller (CPB) through AAPC within 18 months required. 

• Experience with paper and electronic billing for various health insurances, including knowledge of hospital and professional claim forms required. 

• Experience with revenue codes, CPT, HCPCs, and ICD-10 coding experience required. 

• Experience with medical terminology required.

• Previous experience with health insurance and collection techniques required.

• Credentialed as a Certified Professional Coder (CPC) preferred. 

• Must possess the ability to work both independently and as a part of a team.

• Basic word processing proficiency. This includes the ability to: insert tables and bulleted lists; create and utilize form letters; and generate professional-appearing memos and e-mails.

• Beginner proficiency with Microsoft Excel (or other spreadsheet software)

• Must be able to operate computer and software systems in use at Prairie Ridge Health. 

  Shift: Monday-Friday, days. Hybrid work available after training. 

FTE: 1.0

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