Claims Resolution Specialist (Coder) - 1.0 FTE

Prairie Ridge Health Inc.; Columbus (OH); On-site; USD 52,000 - 64,000; Full time

Job summary

Prairie Ridge Health Inc. in Columbus, OH, is hiring a Claims Resolution Specialist to join Business Services. This full-time role handles researching and resolving complex facility and professional insurance denials and ensures timely follow-up of claims.

You will interact with other teams to resolve errors, review accounts, and apply billing follow-up knowledge to maximize reimbursement across payors.

Qualifications

• High school diploma required.
• CPB certification within 18 months of hire preferred.
• Experience with hospital and professional claim forms; CPT/HCPCS/ICD-10 coding knowledge.

Responsibilities

• Research and resolve complex facility and professional insurance denials.
• Ensure timely follow-up of claims.
• Collaborate with other teams to resolve errors and optimize reimbursement.

Skills

Analytical thinking

Attention to detail

Communication

Billing follow-up

Education

High school diploma

CPB (Certified Professional Biller)

CPC (Certified Professional Coder)

Tools

Microsoft Excel

Job description

Prairie Ridge Health is looking for a team member to join Business Services in the role of Claims Resolution Specialist. This position is 1.0 FTE (40 hours per week) and will work Monday - Friday, days. The Claims Resolution Specialist is responsible for researching and resolving complex facility and professional insurance denials and ensures that claims are followed up in a timely manner...

POSITION SUMMARY

The Claims Resolution Specialist is responsible for researching and resolving complex facility and professional insurance denials and ensures that claims are followed up in a timely manner. This position also requires corresponding with other teams on various types of errors to resolve claims needing additional review. They independently review accounts and apply billing follow up knowledge required for all insurance payors to ensure proper and maximum reimbursement. Uses multiple systems to resolve outstanding claims according to compliance guidelines. This role supports the revenue cycle workflows, charge capture, and work queue processes. This position will help optimize the Revenue Cycle by evaluating, validating, and trending data for presentation to all levels of the organization.

EDUCATION REQUIREMENTS/LICENSURE/CERTIFICATION/REGISTRATION

High school diploma (or equivalent) required. Certified Professional Biller (CPB) through AAPC within 18 months of hire, unless existing Certified Professional Coder (CPC) is held required. Experience with paper and electronic billing for various health insurances, including knowledge of hospital and professional claim forms. Experience with revenue codes, CPT, HCPCs, and ICD-10 coding experience. Experience with medical terminology. Previous experience with health insurance and collection techniques. Must possess the ability to work both independently and as a part of a teamCredentialed as a Certified Professional Coder (CPC) preferred. Must possess the ability to work both independently and as a part of a teamBasic word processing proficiency. This includes the ability to: insert tables and bulleted lists; create and utilize form letters; and generate professional-appearing memos and e-mails. Beginner proficiency with Microsoft Excel (or other spreadsheet software)Must be able to operate computer and software systems in use at Prairie Ridge Health.

FTE: 1.0 FTE (40 hours per week)Shift: Monday - Friday, days.