Claims Resolution Specialist

Jacksonville, Florida

Employer: Medix
Industry: Revenue Cycle
Salary: Competitive
Job type: Full-Time
Job Duties:

  • Follows-up on all claims that have been billed out in a timely and effective manner.
  • Work all claims to a zero balance resolution through a compilation of options such as interacting
    with the payer directly, using the payer portal, formally appealing, and/or consideration for appropriate adjustment.
  • Verifies all charges on claims are accurate with correct charge amounts including billing correct
    units.
  • Verifies all patient and insurance information on claims to ensure it is accurate.
  • Understands and stays up to date with contractual rates and billing practices
  • Applies critical thinking skills to resolve a claim utilizing appropriate methods by which to interact
    with the payer through specific process and/or technological tools.
  • Considers the value of seeking medical necessity review , coding review, or charge review depending
    on claim denial issue and collaborates with other departments following established processes.
  • Reports to leadership any trends that are being seen with claim denials or billing errors.
  • Helps identify follow-up issues to find root cause of denial.
  • Comprehends and can trouble shoot claim issues as the specialist work queue is built by rules
    of exception.


3-5 Must Have Skills/Qualifications:

  • Physician billing experience
  • EPIC EMR experience
  • Commercial & Government experience
  • Appeals & Claims Follow up experience
  • payor guidelines


Nice to Have Skills:

  • Surgical billing
  • Cancer facility background

Schedule: Full time Monday through Friday (Flexible start time 6:00am-8:30am after training)

Equipment: Provided

Can only be remote out of the following states:
  • AL
  • FL
  • GA
  • ID
  • IN
  • KY
  • LA
  • MI
  • NC
  • OH
  • OK
  • OR
  • SC
  • SD
  • TN
  • TX
  • VA
  • WV
  • WY

Metrics: 20-25 accounts per day

Training: Monday-Friday mirroring others, then EPIC training
Created: 2024-09-24
Reference: 234183_1727114764
Country: United States
State: Florida
City: Jacksonville
ZIP: 32224

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