Restoring Hope - Returning Health
Claims Resolution Specialist
Location
Arizona + 6 moreAll locations: Arizona | California | Nevada | New Mexico | Oregon | Texas | Washington
Posted
1 day ago
Salary
$28 - $35 / hour
Seniority
Senior
Job Description
Claims Resolution Specialist
Boomerang Healthcare
• Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission • Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues • Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate • Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines • Perform payer research and communicate directly with insurance carriers to resolve claim processing issues • Monitor assigned work queues and ensure timely resolution of outstanding claims • Escalate complex reimbursement, coding, or compliance issues to senior team members • Partner with A/R and Denials Management teams to resolve denied and underpaid claims • Assist in preparing appeal documentation and supporting materials for denied claims • Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator • Maintain accurate documentation of denial resolution activities and payer communications • Support efforts to reduce preventable denials and improve reimbursement outcomes • Work closely with the pre-billing team to identify and correct claim issues prior to submission • Review claims for completeness and compliance with payer billing requirements • Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage • Collaborate with coding and clinical teams to obtain information needed for claim resolution • Assist with reducing claim holds and billing delays • Participate in routine claim quality reviews and internal audit activities • Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines • Support Revenue Integrity initiatives through accurate claim review and documentation • Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements • Adhere to HIPAA, CMS, and organizational compliance standards • Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities • Track assigned workloads and resolution outcomes • Assist with compiling information for denial trend reporting and operational reviews • Provide feedback regarding workflow issues contributing to claim errors or payment delays • Assumes other responsibilities as appropriate to the position and organizational needs
Job Requirements
- High School Diploma or equivalent required
- Associate degree in Healthcare Administration, Medical Billing and Coding, or related field preferred
- Minimum 2-4 years of experience in medical billing, claims resolution, denial management, accounts receivable, or healthcare revenue cycle operations
- Working knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial insurance billing requirements
- Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical terminology
- Experience researching and resolving denied or rejected claims
- Strong analytical and critical thinking skills
- Ability to manage multiple priorities and meet productivity expectations.
Benefits
- Amazing work/life balance
- Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
- 401(K) Plan with Employer Matching
- License & Tuition Reimbursements
- Paid Time Off
- Holiday Pay & Floating Holiday
- Employee Perks and Discount Programs
- Supportive environment to help you grow and succeed
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