Claim Resolution Specialist

Valid8 Financial, Inc.; Monrovia (CA); Remote; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a detail-oriented billing coordinator to manage member billing inquiries and resolve discrepancies. This role involves coordinating with various departments to ensure accurate billing and maintaining documentation in the claims system. Ideal candidates will possess healthcare billing experience and strong communication skills. Join a dynamic team in a fast-paced environment where you can make a significant impact by enhancing member satisfaction and operational efficiency. If you're passionate about healthcare and enjoy problem-solving, this opportunity is perfect for you!

Qualifications

• 1+ year of healthcare billing and/or health plan experience required.
• High School Diploma or equivalent experience is mandatory.

Responsibilities

• Coordinate between departments to resolve member billing issues.
• Respond to member billing inquiries through written correspondences.

Skills

Healthcare billing experience

Multi-tasking skills

Empathy and courtesy

Ability to resolve escalated complaints

Education

High School Diploma / GED

Tools

Google Workspace (Gmail, Sheets, Docs)

Job description

• Coordinate between departments to resolve member billing issues, including, but not limited to contacting providers and/or facilities to update insurance information and resolve billing discrepancies.
• Research claims issues resulting in member balance billing.
• Respond to member billing inquiries through written correspondences and/or phone calls.
• Handle sensitive member interactions.
• Maintain timely, accurate documentation in the claims system for all appropriate transactions.
• Report problems, errors, and denial trends to management including PHI breaches.
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member and provider satisfaction.

Required Qualifications:

• High School Diploma / GED OR equivalent years of working experience.
• Must be 18 years of age OR older.
• 1+ year of healthcare billing and/or health plan experience.

Preferred Qualifications:

• Healthcare / Insurance billing industry experience.
• Medical terminology acumen and experience.
• Billing experience and understanding of multiple billing requirements across various payers and states. Knowledge of billing in the state of Texas is a plus.
• Experience working in the Google workspace (Gmail, Sheets, Docs).

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable).
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive an approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Ability to multi-task and understand multiple products and multiple levels of benefits within each product.
• Previous work experience in a fast-paced environment requiring multi-tasking skills.
• Ability to resolve calls, avoiding escalated complaints.
• Ability to exhibit empathy and be courteous to callers.
• Ability to triage and handle escalated situations.
• Ability to work in a fast-paced environment.
• Ability to adapt to changes.
• Ability to work independently and as part of a team.