What are the responsibilities and job description for the Claims Resolution Specialist position at VieMed?
Duties:
- Review and understand Insurance policies and standard Explanation of Benefits.
- Review and understand medical documentation effectively
- Review and resolve Back Collections related tasks, such as
- Denial appeals
- Payment review and balance billing
- Claims generation
- Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient’s benefit.
- Performs other clerical tasks as needed, such as
- Answering patient/Insurance calls
- Faxing and Emails
- Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor
- Other responsibilities and projects as assigned.
Requirements:
- 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.
Experience:
- 3-5 Years in DME or medical billing experience preferred.
- Minimum of 1 year of insurance verification or authorizations required.
Skills:
- Superior organizational skills.
- Proficient in Microsoft Office, including Outlook, Word, and Excel.
- Attention to detail and accuracy.
- Effective/professional communication skills (written and oral)