Claims Resolution Specialist

Job Summary

A company is looking for a Claims Resolution Specialist- Remote.

Key Responsibilities

• Validate denial reasons and ensure accurate coding in the DCM system
• Generate appeals based on dispute reasons and payer guidelines
• Research contract terms and compile documentation for appeals

Required Qualifications, Training, and Education

• High School Diploma or equivalent; some college coursework preferred
• 3 - 5 years experience in a hospital business environment, focusing on billing and/or collections
• Intermediate understanding of EOB forms, managed care contracts, and hospital billing requirements
• Intermediate knowledge of ICD-9, HCPCS/CPT coding, and medical terminology
• Intermediate Microsoft Office skills