Medical Claims Resolution Specialist

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

Job summary

Rhode Island Hospital is seeking an experienced claims follow-up specialist to correct denied claims for a large physician multi-specialty practice. The role emphasizes accuracy, HIPAA compliance, and timely resolution of payer issues in a collaborative environment.

Under supervision, you will review denials, gather supporting documentation, and communicate with payers to resolve discrepancies ensuring efficient adjudication and quality service for patients and providers in Providence, RI.

Qualifications

• One to three years of professional billing experience.
• Epic experience is a plus.
• Knowledge of ICD, CPT, HCPCS and 1500 claim forms.

Responsibilities

• Review all denied claims, correct them in the system and send corrected/appealed claims.
• Identify and analyze denials and enact corrective measures with payers.
• Maintain HIPAA compliance when handling patient information.
• Contact internal departments to obtain missing or erroneous information on a claim.
• Report denial trends to improve revenue delays.
• Answer inquiries from 3rd party payers and route unusual requests as needed.
• Retrieve medical records documentation for third party requests.

Skills

Critical thinking

Diplomacy

Relationship-building

Communication skills

Teamwork

Education

High school diploma

Tools

Epic

Job description

Rhode Island Hospital is seeking an experienced claims follow-up specialist to correct denied claims for a large physician multi-specialty practice. The role emphasizes accuracy, HIPAA compliance, and timely resolution of payer issues in a collaborative environment.

Under supervision, you will review denials, gather supporting documentation, and communicate with payers to resolve discrepancies ensuring efficient adjudication and quality service for patients and providers in Providence, RI.