Claims Escalation and Resolution Specialist I

Remote Jobs; Pennsylvania; Remote; USD 80,000 - 100,000; Full time

Job summary

A flexible healthcare organization in the United States is seeking an experienced professional for remote EMS billing management. The role involves reviewing and managing claim statuses, resolving issues, and collaborating on process improvements. Candidates should have at least three years of EMS billing experience, relevant certifications, and strong knowledge of billing rules. This opportunity offers significant career advancement within a supportive environment.

Benefits

100% remote work flexibility

Career advancement opportunities

Collaborative work environment

Qualifications

• Minimum of 3 years of experience in EMS billing preferred.
• Certification as a Certified Ambulance Coder (CAC).
• Knowledge of EMS billing rules and regulations.

Responsibilities

• Review and manage claim statuses including error, denied, and rejected claims.
• Collaborate with the Resolution Manager to provide updates.
• Consistently meet daily performance metrics for claim resolution.

Skills

EMS billing knowledge

Claim management

Problem-solving

Education

High School Diploma

Tools

Billing platforms

Job description

Overview

Why consider this job opportunity:

• 100% remote work flexibility
• Opportunity for career advancement within the organization
• Supportive and collaborative work environment
• Competitive focus on quality and performance metrics
• Chance to make a significant impact on the billing and reimbursement processes for emergency medical services

Responsibilities

• Review and manage claim statuses, including error, denied, and rejected claims
• Identify root causes and work on resolving claims in specified statuses
• Collaborate with the Resolution Manager to provide updates and revise SOPs as necessary
• Participate actively in daily resolution team huddles
• Consistently meet daily performance and quality metrics for claim resolution

Qualifications

• High School Diploma required
• Minimum of 3 years of experience in EMS billing preferred
• Certification as a Certified Ambulance Coder (CAC)
• QMC Biller Certification
• Strong working knowledge of EMS billing rules and regulations, as well as health insurance payor groups (Medicare, Medicaid, Commercial)

Preferred Qualifications

• Knowledge of RCM industry billing platforms