Claims Resolution Specialist-I

• Conduct AR Follow-up both on front end scrubs and back-end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
• Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
• Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
• Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
• Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
• Contact insurance companies and utilize web portals and websites for appeal, eligibility, remittance, and payment information.
• Candidates must be able to report and communicate issues and trends.
• Meet or exceed productivity expectations of a minimum average of 6 denials per hour (approximately 45 per day), while maintaining accuracy and quality standards.
• Highly productive and able to stay focused in a remote environment. 
• Ability to demonstrate mastery of the above essential functions with passing grades in a testing environment. 
• Other duties as assigned.

• 3+ years of experience in claims resolution or medical billing.
• A minimum of 2 years of documented experience on the Athena billing platform is highly preferred.  Additional EMR experience including Cerner, NextGen, and EPIC is a plus. and able to pass skills test on the platform.
• Formal certification in medical billing preferred but not required. .
• Working knowledge of CPT, ICD-10, and medical terminology.
• Complete understanding of follow-up processes.
• Solid background in AR and overall Revenue Cycle policies and procedures.
• Experience working in a medical billing environment where compliance with protected health information and HIPAA compliance is strongly enforced.
• Excellent communications skills.
• Excellent systems experience and acuity. (EMR and Billing and Collection Systems). Multi-system and multi-specialty experience is preferred.
• Proficiency in Microsoft Office Suite, including Word and Excel. 
• Bachelor’s degree, medical billing certificate preferred. 
• Ability to communicate orally and in writing in a clear and straightforward manner.
• Ability to communicate effectively with senior leadership and company personnel.
• Ability to effectively plan/manage/lead projects.
• Ability to make decisions and solve problems while working under pressure.
• Ability to prioritize and organize effectively.
• Ability to show judgment and initiative and to accomplish job duties.
• Ability to work independently.
• Strong business acumen
• Effective communication skills including public speaking.

• A standard business environment exists with moderate noise levels. 
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis. 
• Ability to sit for extended periods of time.  
• Long periods of computer usage
• Handling – seizing, holding, grasping and fingering of objects, tools and controls
• Vision – close vision
• Hearing- ability to receive detailed information through oral and telephonic communication

We offer competitive benefits to set you up for success in and outside of work.

Innovaccer does not charge fees or require payment from individuals or agencies for securing employment with us. We do not guarantee job spots or engage in any financial transactions related to employment. If you encounter any posts or requests asking for payment or personal information, we strongly advise you to report them immediately to our HR department at px@innovaccer.com. Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details.