Medical Claims Resolution Specialist Job at Robert Half (Indianapolis)

Claims Resolution Specialist I, Hospital Billing Office

Baptist Health is hiring a Claims Resolution Specialist I for our Hospital Billi...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Accounts Receivable Experience Required
Billing Experience Required
Knowledge of CPT, ICD10, HCPCS, and Modifiers Required
Medical Insurance Experience Required
Reimbursement Experience Required
1-2 years of Revenue Cycle Operations Experience Required
High school diploma (or higher) Required

Job Responsibility

Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers
Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities
Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims
Follows-up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims
Works all assigned accounts on worklist in order depending on balance and age
Identify and communicate trends in denials to leadership
Requires experience in either HB or PB while working toward competency in all areas of the assigned vertical
Communicates with various departments to resolve any outstanding issues with claim to resolve denials
Possesses up to date knowledge related to CPT codes, ICD/10 codes

Fulltime

Claims Resolution Specialist II

Baptist Health is hiring a Claims Resolution Specialist II for our Physician Bil...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

High School Diploma/GED
1-2 years Revenue Cycle Operations Experience Required
Less than 1 year Billing Experience Required
Less than 1 year Medical Insurance Experience Required
Less than 1 year Reimbursement Experience Required
Less than 1 year Accounts Receivable Experience Required
Less than 1 year Knowledge of CPT, ICD10, HCPCS and Modifiers Required

Job Responsibility

Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers
Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities
Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims
Follows-up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims
Works all assigned accounts on worklist in order depending on balance and age
Identify and communicate trends in denials to leadership
Requires experience in either HB or PB while working toward competency in all areas of the assigned vertical
Communicates with various departments to resolve any outstanding issues with claim to resolve denials
Possesses up to date knowledge related to CPT codes, ICD/10 codes

Fulltime

Medical Claims Specialist

We are looking for a dedicated Medical Claims Specialist to join our healthcare ...

Location

United States , Federal Way

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical collections, claims resolution, or revenue cycle management
Strong ability to interpret insurance contracts, documents, and regulatory guidelines
Knowledge of benefit verification and authorization processes within healthcare
Analytical skills to identify and address root causes of claim denials effectively
Reliable high-speed internet and familiarity with secure remote work systems
Proficiency in video conferencing and adherence to remote communication protocols
High level of responsiveness, urgency, and accountability in managing tasks
Ability to work exclusively for the organization without concurrent external roles

Job Responsibility

Conduct detailed benefit verification for patient insurance coverage to ensure accurate claims submission
Investigate and resolve unpaid or denied claims by analyzing root causes and utilizing available resources
Communicate effectively with insurance payers to address claim issues and facilitate timely payment
Interpret insurance contracts and regulations, ensuring compliance with state and employer-specific requirements
Participate in virtual meetings promptly, adhering to meticulous standards and security protocols
Utilize secure systems to manage sensitive data in a remote environment
Verify insurance authorizations and approvals accurately to support seamless claim processing
Collaborate with team members to resolve complex payment barriers and ensure smooth operations
Manage and resolve a set number of complex accounts daily, meeting productivity expectations
Respond promptly to supervisor and leadership inquiries during work hours, maintaining a high level of accountability

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Medical billing claims collections specialist

We are looking for experienced professionals to assist with medical billing, cla...

Location

United States , Austin

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical billing, claims processing, and collections
Strong knowledge of accounts receivable management, particularly aged accounts
Familiarity with insurance follow-up processes, including handling denials and claim status evaluations
Understanding of appeals and resubmission procedures for various insurance types
Ability to interpret EOBs and ERAs to accurately assign financial responsibilities
Excellent communication skills for patient collections and negotiations
Proficiency in handling sensitive financial conversations with empathy and professionalism
Knowledge of Medicare, Medicaid, and commercial insurance regulations and processes

Job Responsibility

Conduct follow-ups on aged accounts receivable to ensure timely resolution and recovery
Review and analyze claims to determine appropriate actions, including resubmissions, appeals, write-offs, or patient collections
Manage patient collections by initiating contact, negotiating payment plans, and addressing financial concerns with sensitivity
Handle invoicing tasks, ensuring accuracy and compliance with organizational protocols
Evaluate insurance denials and claims statuses to identify resubmission opportunities and payer-specific requirements
Process appeals and resubmissions, adhering to industry standards and documentation guidelines
Interpret explanation of benefits (EOBs) and electronic remittance advices (ERAs) to determine financial responsibility between payers and patients
Collaborate with team members to ensure efficient handling of accounts and claims
Maintain detailed records of all actions taken for claims and collections
Utilize knowledge of commercial and government insurance processes, including Medicare and Medicaid, to guide decision-making

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Patient Billing Resolution Specialist

Robert Half is seeking skilled, customer-oriented Patient Billing Resolution Spe...

Location

United States , Denver

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High School Diploma/GED
Minimum 2 years of medical insurance billing and denials
Excellent communication and problem-solving skills
Experience with appeals and denials

Job Responsibility

Oversee the Coordination of Benefits to assist patients with managing billing and denials
Act as liaison between patients and insurance companies
Handle high-volume communication: letters, text messages, and three-way calls
Investigate accounts thoroughly to achieve optimal resolution—primarily getting insurance to pay claims
Maintain documentation and patient files through the resolution process

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Patient Billing Resolution Specialist

Robert Half is seeking skilled, customer-oriented Patient Billing Resolution Spe...

Location

United States , Atlanta

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High School Diploma/GED
Minimum 2 years of medical insurance billing and denials
Excellent communication and problem-solving skills
Experience with appeals and denials

Job Responsibility

Oversee the Coordination of Benefits to assist patients with managing billing and denials
Act as liaison between patients and insurance companies
Handle high-volume communication: letters, text messages, and three-way calls
Investigate accounts thoroughly to achieve optimal resolution—primarily getting insurance to pay claims
Maintain documentation and patient files through the resolution process

What we offer

medical, vision, dental, and life and disability insurance
401(k) plan

Fulltime

Senior Workers’ Compensation Claims Specialist

We are looking for a fully remote Senior Workers’ Compensation Claims Specialist...

Location

United States , Chicago

Salary:

25.00 - 40.00 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

Hold a valid New York adjuster's license
Manage a complex caseload of workers’ compensation claims from inception through resolution
Ensure compliance with applicable laws and regulations
Deliver excellent customer service
Work closely with internal stakeholders, injured employees, medical providers, and legal counsel

Job Responsibility

Manage a portfolio of high-exposure and complex workers’ compensation claims, including litigated cases
Investigate claims by reviewing reports, medical records, and conducting interviews to determine compensability
Ensure timely and accurate claim adjudication in accordance with state laws and company guidelines
Develop and execute claim strategies, including reserve setting and ongoing reserve adjustments
Coordinate with medical providers, rehabilitation specialists, and case managers to support return-to-work initiatives
Monitor and manage litigation, working closely with defense attorneys and attending hearings, mediations, and depositions as needed
Communicate regularly with injured employees, employers, brokers, and other stakeholders regarding claim status

What we offer

Medical
Vision
Dental
Life and disability insurance
Eligibility to enroll in company 401(k) plan

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...

Location

United States of America , Albany

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate degree and 2 years of related relevant experience
or equivalent combination of education and/or experience
Excellent problem-solving skills
Excellent communication skills
Excellent customer service skills

Job Responsibility

Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
Research claims, identify problems, and takes appropriate action to assure claim resolution
Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
Keeps management informed of changes in billing requirements and rejection or denial codes
Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists

Fulltime

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Medical Claims Resolution Specialist

Job Description

Job Responsibility

Requirements

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What we offer

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