Resolution Analyst – Denials

Jobtailor; Deutschland; Remote; EUR 42.000 - 66.000; Vollzeit

Zusammenfassung

Jobtailor seeks a Resolution Analyst to liaison between client contacts and our denials/underpayment appeal process with payers. You will facilitate payment review recovery efforts for denied and underpaid accounts for assigned clients, increasing department revenue.

This role handles PHI with strict privacy and security, requiring accuracy, contract knowledge, and timely payer/client communication in healthcare billing.

Qualifikationen

• High School Diploma or GED required; associates or bachelor's degree preferred.
• 5+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate understanding of insurance payer/provider claims processing and data requirements.
• Familiarity with hospital reimbursement, managed care contracts, and relevant federal/state requirements.

Aufgaben

• Liaise between key client contacts and denials/underpayment appeal processes with payers.
• Facilitate payment review recovery efforts for denied and underpaid accounts for assigned clients.
• Handle patient health information (PHI) with strict privacy and security compliance.

Ausbildung

High School Diploma or GED

Associates or Bachelor's Degree preferred

Tools

MS Office

Word

Excel

Outlook

Jobbeschreibung

• The Resolution Analyst acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer.
• The Resolution Analyst is responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the departments revenue.
• This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Requirements

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 5+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
• Strong understanding of the revenue cycle process.
• Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
• Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
• Intermediate understanding of EOB, hospital billing form requirements (UB04), and familiarity with the HCFA 1500 forms.
• Demonstrate strong ability to review client/payer contracts to identify complex underpayments.
• Regular and predictable attendance.

Core Competencies

Demonstrates expertise in healthcare billing and collections, with a strong understanding of the revenue cycle process and insurance claims processing. Proficient in handling patient health information while ensuring compliance with privacy and security standards.

Highest-signal resume keywords

• Healthcare Billing Experience
• Insurance Claims Processing
• Revenue Cycle Management
• ICD, HCPCS/CPT Coding
• Client Facing/Customer Service Experience

ATS Optimization Keywords

Hard Skills

• Healthcare Billing
• Claims Processing
• Revenue Cycle Management
• ICD Coding
• HCPCS Coding
• CPT Coding
• EOB Understanding
• Hospital Billing Forms
• Managed Care Contracts
• Data Requirements

Soft Skills

• Strong Communication
• Attention to Detail
• Problem Solving

Industry Keywords

• Patient Health Information
• Denials and Underpayment Appeals
• HMO
• PPO
• IPA
• Capitation
• Federal and State Requirements

Tools & Technologies

• MS Office
• Word
• Excel
• Outlook