Claims Resolution Specialist

JOB OVERVIEW

Our Claims Resolution Specialist role is responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy while maintaining appropriate documentation and account records, as well as timely issue resolution. In this role, you will ensure work is in compliance with all legal, regulatory, and internal Integra policies and procedures, including HIPAA compliance. If you have previous medical billing or claims experience, this role may be of interest as a next step in your career.
 
JOB RESPONSIBILITIES

• Accountable for daily productivity goals at or above the current production metric
• Maintain a climate of teamwork and collaborative problem solving
• Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectives
• Stay informed on product information, changes in Medicare/State/Contract funding procedures, and updates in policies and procedures
• Contribute beyond fundamental responsibilities to support company growth and department development
• Adds value and positive contributions towards the company and department culture
• Understand and perform duties in compliance with State and Federal regulations and the policies and procedures of Integra
• Achieve and maintain an individual effectiveness rate of 70% +
• Contributes to the department maintaining AR aging over 120 days at 10% or less of total inventory
• Strong Microsoft Office skills (Excel in particular) and ability to learn new programs and software
• Must type 45+ words per minute
• Familiar with ICD-10, HCPCS, and medical terminology
• Ability to follow verbal and written instructions
• Ability to maintain consistent, regular attendance and punctuality
• Performs miscellaneous duties as assigned

WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?

• In the first 6 months you will learn Integra’s claims platform (QUE) and how to navigate it thoroughly (i.e. transmit new claims to payers, submit corrected claims, update member information, adjust off correctly adjudicated claims, etc.).
• You will learn your job role and responsibilities and which tools/references are available to you to assist in resolving unpaid claims.
• You will build your knowledge base in relation to the insurance plans one plan at a time, so that in 6 months you are the subject matter expert on those plans and are able to spot any payer issue trends.
• During this time you will set measurable goals for personal development and growth.

WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?

• You will be fully integrated with your job, company and team.
• You will continue to learn additional insurance plans and become a subject matter expert on multiple plans.
• You will contribute your skills and knowledge to meet your department’s metrics and goals.
• You will have regular monthly one-on-one meetings with leaders for mutual feedback and have initiated your personal development plan so you have started to define a path for growth.

COMPENSATION: $19.00/hour

EXPERIENCE:

• Familiarity with the 1500 claim forms, and DMEPOS services
• Knowledge of ICD-10, HCPCS, and medical terminology
• Understanding of CMS guidelines, and Medical Policy adopted by the plan
• Correctly read and assess medical documents
• Must type 45+ words per minute
• Computer experience, and the ability to learn new programs and software, Microsoft Word and Microsoft Excel background is a necessity
• Conduct yourself in a courteous, helpful, and professional manner at all times
• Passion for your work and the mission of the company
• Motivated and able to work independently within a fast-paced, team environment
• Must be organized and thorough
• Sound judgement and critical thinking
• Ability to work overtime as required
• Must follow policies regarding attendance and punctuality
• Meet all daily productivity and weekly quality goals