Patient Claims Resolution Specialist

Charleston Area Medical Center; Charleston (WV); On-site; USD 36,000 - 48,000; Full time

Job summary

Charleston Area Medical Center in Charleston, WV seeks a Patient Accounts Resolution Specialist for General Hospital to review unpaid and underpaid claims, ensuring payments are accurate and timely per policies and payer contracts.

You will collaborate with coding, Utilization Review, and payer representatives to resolve denials, perform follow-up, rebill when needed, and thoroughly document all actions in the encounter timeline.

Qualifications

• Healthcare billing and collections knowledge.
• Ability to interpret payer EOB.
• Ability to identify and resolve claim issues.
• Excellent communication and customer service skills.
• Computer and keyboarding skills.
• Microsoft Excel and Word familiarity.
• Cerner knowledge.

Responsibilities

• Review unpaid and underpaid claims to resolve at-risk, past due, and technical denial issues.
• Coordinate with coding to resolve denials.
• 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.
• Contact physician offices to obtain information needed to resolve claims.
• Document all steps in the encounter timeline and ensure follow-up is thorough.

Skills

Healthcare billing

EOB interpretation

Claim issue resolution

Communication

Computer skills

Excel/Word familiarity

Cerner knowledge

Education

High School Diploma or GED

Tools

Excel

Word

Cerner

Job description

Charleston Area Medical Center in Charleston, WV seeks a Patient Accounts Resolution Specialist for General Hospital to review unpaid and underpaid claims, ensuring payments are accurate and timely per policies and payer contracts.

You will collaborate with coding, Utilization Review, and payer representatives to resolve denials, perform follow-up, rebill when needed, and thoroughly document all actions in the encounter timeline.