Claims Resolution Specialist

Jobtailor; Kansas; On-site; USD 42,000 - 64,000; Full time

Job summary

Jobtailor is seeking a Healthcare Billing Specialist to review, submit, and monitor SSI claims with accuracy. You will ensure demographics, insurance details, coding, and authorization requirements are complete before submission, and address issues to maintain clean claim rates.

Ideal candidates have 2+ years in healthcare billing, familiarity with MEDITECH, SSI, CPT/HCPCS/ICD-10, and the ability to work under pressure to meet deadlines in a fast-paced environment.

Qualifications

• High School Diploma or equivalent.
• 2+ years of healthcare billing or revenue cycle experience.
• Residency in Missouri or Kansas is required.
• Experience with MEDITECH EHR system preferred.
• Experience working in SSI clearinghouse preferred.
• Basic understanding of CPT, HCPCS, and ICD-10 coding.
• Basic understanding of insurance billing processes.
• Basic understanding of claim submission workflows.
• Attention to detail and accuracy.
• Time management and ability to meet deadlines.
• Strong organizational skills.
• Effective communication and teamwork.
• Ability to follow standardized workflows.
• Ability to sit and stand intermittently for 8 to 10 hours a day.

Responsibilities

• Review errored and rejected claims in SSI.
• Ensure patient demographics, insurance, coding, modifiers, units, and authorization requirements are complete before submission.
• Submit claims electronically or via clearinghouse in a timely manner.
• Monitor and resolve claims in error, hold, wait, and rejected statuses.
• Maintain payer enrollment.
• Validate claims against CMS billing guidelines, payer-specific requirements, and organizational policies.
• Identify and elevate discrepancies to Billing QA, Coding, Patient Access, or the Manager.
• Maintain assigned SSI work queues and work accounts daily.
• Meet productivity and turnaround targets and prevent backlog accumulation.
• Release claims within the established SLA, typically under 24 hours after readiness.
• Identify trends in claim holds or delays and communicate recurring issues to leadership or the Revenue Cycle Analyst.
• Collaborate with cross-functional teams to resolve claim submission barriers.
• Maintain high accuracy and support clean claim rate goals.
• Follow departmental workflows and documentation standards.
• Maintain regular and predictable attendance.
• Perform other essential duties as assigned.

Skills

Healthcare billing experience

Claim submission workflows

Attention to detail

Time management

Organizational skills

Effective communication

Teamwork

Education

High School Diploma or equivalent

Tools

MEDITECH

Clearinghouse

SSI

EHR System

Job description

Responsibilities

• Review errored and rejected claims in SSI
• Ensure patient demographics, insurance, coding, modifiers, units, and authorization requirements are complete before submission
• Submit claims electronically or via clearinghouse in a timely manner
• Monitor and resolve claims in error, hold, wait, and rejected statuses
• Maintain payer enrollment
• Validate claims against CMS billing guidelines, payer-specific requirements, and organizational policies
• Identify and elevate discrepancies to Billing QA, Coding, Patient Access, or the Manager
• Maintain assigned SSI work queues and work accounts daily
• Meet productivity and turnaround targets and prevent backlog accumulation
• Release claims within the established SLA, typically under 24 hours after readiness
• Identify trends in claim holds or delays and communicate recurring issues to leadership or the Revenue Cycle Analyst
• Collaborate with cross-functional teams to resolve claim submission barriers
• Maintain high accuracy and support clean claim rate goals
• Follow departmental workflows and documentation standards
• Maintain regular and predictable attendance
• Perform other essential duties as assigned

Requirements

• High School Diploma or equivalent
• 2+ years of healthcare billing or revenue cycle experience
• Residency in Missouri or Kansas is required
• Patient Access / Registration experience preferred
• Experience working in an EHR system (MEDITECH preferred)
• Experience working in clearinghouse (SSI Preferred)
• Basic understanding of CPT, HCPCS, and ICD-10 coding
• Basic understanding of insurance billing processes
• Basic understanding of claim submission workflows
• Attention to detail and accuracy
• Time management and ability to meet deadlines
• Strong organizational skills
• Effective communication and teamwork
• Ability to follow standardized workflows
• Ability to sit and stand intermittently for 8 to 10 hours a day
• Ability to use standard office equipment, including the telephone and computer keyboard
• Ability to work under pressure while meeting near 100% accuracy and inflexible deadlines
• Manual/bi-manual dexterity, near vision, speech, and hearing
• Ability to lift and/or carry up to 40 lbs.
• Ability to occasionally walk on uneven surfaces

Core Competencies

Demonstrates expertise in healthcare billing processes, including claim submission workflows and coding standards such as CPT, HCPCS, and ICD-10. Proven ability to maintain accuracy and meet productivity targets while collaborating with cross-functional teams to resolve claim issues.

Highest-signal resume keywords

• Healthcare Billing Experience
• Claim Submission Workflows
• CPT, HCPCS, ICD-10 Coding
• EHR System Experience
• Attention to Detail

Hard Skills

• Claim Review
• Payer Enrollment
• Claims Validation
• Insurance Billing Processes
• Claims Monitoring
• Productivity Targets
• Documentation Standards
• Error Resolution
• Standardized Workflows
• Manual Dexterity

Soft Skills

• Effective Communication
• Time Management
• Organizational Skills
• Teamwork
• Ability to Work Under Pressure

Industry Keywords

• Revenue Cycle
• Patient Access
• Claims Processing
• CMS Billing Guidelines
• Healthcare Compliance

Tools & Technologies

• EHR System
• MEDITECH
• Clearinghouse
• SSI