Claims Resolution Specialist

Rhode Island Hospital; Providence (RI); On-site; USD 28,000 - 45,000; Full time

Job summary

Brown University Health is seeking a Claims Follow-up Specialist to review denied claims, correct entries, and submit appeals for a large physician multi-specialty practice in Providence, RI.

Under general supervision, you will identify denial trends, communicate with payers and internal departments, and ensure timely adjudication while maintaining HIPAA standards. Experience with Epic is a plus; high school diploma required.

Qualifications

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing including ICD, CPT, HCPCS and 1500 claim forms.
• Demonstrated skills in critical thinking, diplomacy and relationship-building.
• Highly developed communication skills with diverse groups.

Responsibilities

• Review denied claims, correct in system, and resubmit appeals.
• Identify and analyze denials; implement corrective measures.
• Monitor payer updates via listservs, provider updates, webinars and sites.
• Maintain HIPAA compliance when handling patient information.
• Contact internal departments for missing or erroneous claim data.
• Report denial trends to improve revenue delays.
• Answer phone inquiries from 3rd party payers; escalate unusual requests.
• Retrieve medical records based on third-party requests.
• Refer unresolved accounts to supervisor for further review.
• Assist management to streamline processes and improve accuracy.

Skills

3rd party billing

ICD CPT HCPCS

Communication skills

Problem solving

HIPAA compliance

Education

High School Diploma

Tools

Epic

Job description

Brown University Health is seeking a Claims Follow-up Specialist to review denied claims, correct entries, and submit appeals for a large physician multi-specialty practice in Providence, RI.

Under general supervision, you will identify denial trends, communicate with payers and internal departments, and ensure timely adjudication while maintaining HIPAA standards. Experience with Epic is a plus; high school diploma required.