Medical Claims Resolution Specialist (Flexible schedule options)

Department: Revenue Cycle

Location: Austin, TX

Description

Aspire Allergy & Sinus is seeking a full-time Medical Claims Resolution Specialist to evaluate assigned payers to include working rejections, invalid and denied claims, appeals and follow-up to bring the account to final resolution on open accounts within a timely manner and to Industry-standard benchmarks. This position ensures accounts receivable compliance within industry rules, regulations, practice protocols in addition to company policy.
Schedule OptionsWe offer flexible scheduling options, including:

• 4-day workweek: Four 10-hour shifts with either Monday or Friday off
• Traditional schedule: Monday–Thursday, 8:00 AM–5:00 PM and Friday, 8:00 AM–12:00 PM
• Early schedule option: 7:00 AM–4:00 PM

No evenings, weekends, or major holidays required.

Location- Full-time onsite work required5929 Balcones Drive, Suite 200
Austin, TX 78731

Key Responsibilities

• Responsible for daily monitoring of invalid, rejections, and denials populated by the clearing house. Diagnosis the error messages and make necessary corrections so the claim can be accepted to the payer electronically
• Demonstrate a thorough understanding of the Accounts Receivable function and compliant with Federal and State regulations and Aspire Allergy & Sinus Center policy and procedures
• Works Insurance Accounts Receivable reports per Revenue Cycle Manager work plan beginning with >120 aging top dollar working in descending order. Research claim denial reasons and take appropriate follow up action for resolution
• Work correspondence in a timely fashion to include submission of medical records when requested
• Demonstrate the ability to effectively communicate and explain benefits, statements and EOB’s to patients and/or front office staff
• Contact insurance companies for payments requests, overdue payments, denied claims etc.
• Identify refunds and complete refund request according to company policy
• Clearly and accurately document issues and actions taken in accounts
• Identify and document new payer denial trends and notify supervisor for escalated follow up
• Maintain strong communication with Billing management team
• Escalate unresolved claim denials to Billing management team for follow up with health plan provider representatives
• Ensure compliance with Aspire Allergy & Sinus Center Policies and Procedures to maximize efficiency
• Maintain strong working knowledge of Allergy, Asthma & Sinus coding
• Maintain confidentiality of all information related to patients, medical staff, finances and cost-effective healthcare delivery issues
• Other duties as assigned to include phone coverage
  
  
  

Skills, Knowledge & Expertise

• Excellent mathematical skills, computer skills, Microsoft applications and word processing programs skills and a minimum of 40 words per minute required
• Excellent writing and verbal communication skills
• Strong phone skills, inbound or outbound
• Strong attention to detail, goal oriented
• Ability to prioritize and manage multiple abilities
• Ability to work in a results-oriented and fast-paced environment, both individually and as part of a team
• Able to establish and maintain effective working relationships with the insurance carriers, patients and employees.
• Must respect the confidential nature of medical information.
  
  
  

Requirements

• 4 years billing experience within the healthcare industry
• 4 years A/R experience with proven record collecting on accounts

Benefits & Perks

• Medical, Dental and Vision Insurance
• Generous Paid Time Off and Paid Holidays
• 401(k) Generous Employer Match
• Life Insurance
• Gym Membership Discounts

Aspire Allergy & Sinus is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.