Claims Resolution Specialist — Patient Billing & Denials

Charleston Area Medical Center; North Charleston (WV); On-site; USD 25,000 - 30,000; Full time

Job summary

Charleston Area Medical Center General Hospital seeks a Patient Accounts Resolution Specialist to review unpaid/underpaid claims and ensure accurate, timely payment per policies, payer contracts, and regulations. You will follow up on denials, coordinate with coding and UR to resolve issues, and document actions in the encounter timeline.

Responsibilities include communicating with payers and physician offices, rebilling to prevent denials, and maintaining updated records for ongoing balances.

Qualifications

• High School Diploma or GED required.
• 1–2 years Collections or customer service experience; medical terminology background preferred.
• 5–7 years related experience preferred.

Responsibilities

• Review unpaid/underpaid claims to ensure accurate, timely payment per policies and contracts.
• Follow up on unpaid claims to ensure complete resolution and thorough documentation.
• Collaborate with coding to resolve denial issues.
• Coordinate with Utilization Review to resolve authorization denials and appeals.
• Use payer portals and DDE systems to obtain claim information for resolution.
• Contact payers by phone to resolve claim issues and obtain information.

Skills

Healthcare billing

collection knowledge

payer EOB interpretation

claim issue resolution

customer service

communication skills

computer skills

Education

High School Diploma or GED

Tools

Cerner

Microsoft Excel

Microsoft Word

Job description

Charleston Area Medical Center General Hospital seeks a Patient Accounts Resolution Specialist to review unpaid/underpaid claims and ensure accurate, timely payment per policies, payer contracts, and regulations. You will follow up on denials, coordinate with coding and UR to resolve issues, and document actions in the encounter timeline.

Responsibilities include communicating with payers and physician offices, rebilling to prevent denials, and maintaining updated records for ongoing balances.