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LHH · 1 week ago

Claims Resolution Specialist

Cincinnati, OH

Full-time

Onsite

Entry, Mid Level

$20/hr - $23/hr

2+ years exp

LHH Recruitment Solutions is partnering with their client to hire a Claims Resolution Specialist. This role is critical in ensuring timely and accurate resolution of outstanding medical accounts receivable and insurance claims, requiring strong experience in medical billing and claims follow-up.

Human Resources

Hiring Manager

Bianca Kimble

Responsibilities

Coordinate workflow for resolving outstanding medical accounts receivable and rejected/pending claims

Review and interpret EOB denials and process daily correspondence

Request and organize medical records or additional information required by insurance companies

Communicate with insurance carriers via web portals, telephone, and fax; prepare appeals and include supporting medical reports

Respond to inquiries from insurance companies, patients, and providers

Maintain A/R averages and meet key performance indicators including days in A/R, net collection %, non-contractual write-offs, and A/R over 120 days

Use monthly aging reports to follow up on unpaid claims aged over 30 days

Serve as a resource to supervisors and leadership on billing and coding issues ( CPT-4, HCPCS, LCD/LMRP, ICD-9/10 )

Ensure all work meets required timeframes and regulatory guidelines

Work assigned queues in the task manager per documented procedures

Escalate priority issues to appropriate management and notify leadership of undocumented processes requiring updates

Perform other related duties as assigned

Qualification

Medical billing experienceInsurance claims follow-upCPT-4HCPCSICD-9/10GE Centricity Practice SolutionsMedical terminology knowledgeHIPAA knowledgeAttention to detailCommunication skillsWork independently