Claims Resolution Specialist (Coder) - 1.0 FTE

Prairie Ridge Health Inc.; Town of Columbus (WI); On-site; USD 50,000 - 70,000; Full time

Job summary

Prairie Ridge Health is seeking a Claims Resolution Specialist for its Business Services team. This 1.0 FTE (40 hours/week) role works Monday–Friday, days, handling research and resolution of complex insurance denials and follow-up to maximize reimbursement.

The position supports revenue cycle workflows, charge capture, and work queues while collaborating with other teams as needed. The ideal candidate will have a high school diploma, CPB certification within 18 months (or CPC held), and

Qualifications

• High school diploma (or equivalent) required.
• CPB certification within 18 months of hire, unless CPC already held.
• Experience with paper and electronic billing for various health insurances.

Responsibilities

• Research and resolve complex facility and professional insurance denials.
• Ensure claims are followed up in a timely manner.
• Correspond with other teams on errors to resolve claims needing review.

Education

High school diploma

Certified Professional Biller (CPB)

Certified Professional Coder (CPC)

Tools

Microsoft Excel

Job description

Job Description

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 team

• Credentialed as a Certified Professional Coder (CPC) preferred.

• Must possess the ability to work both independently and as a part of a team

• Basic 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.